Pupil and motility disorders Flashcards
Which muscles are involved in constriction?
circular muscles of iris
Which muscles are involved in pupil dilation?
dilator muscles
Which artery involvement can result in third nerve palsy?
posterior communicating artery
Which type of headache can cause constricted pupil?
cluster headache
List two differentials for abnormal pupil shape
Trauma- cataract surgery, eye operations
anterior uveitis
acute angle closure glaucoma
List three differentials for mydriasis= dilated pupil
Third nerve palsy
Holmes-Adie syndrome
Raised intracranial pressure
Congenital
Trauma
Stimulants such as cocaine
Anticholinergics
List three differentials for miosis= constricted pupil
Horners syndrome
Cluster headaches
Argyll-Robertson pupil (in neurosyphilis)
Opiates
Nicotine
Pilocarpine
State three features of third nerve palsy
ptosis
dilated non reactive pupil
squint- down and out position
Which structures does the oculomotor nerve supply?
Four muscles apart from superior oblique and lateral rectus (abducens)
+ levator palpabrae superioris
parasympathetic fibres
List three differentials for third nerve palsy
idiopathic
tumour
trauma
cavernosus sinus thrombosis
posterior communicating artery aneurysm
raised ICP
What is the triad of horner’s syndrome?
ptosis
miosis= constricted pupil
anhidrosis= loss of sweating
List three differentials for Horner’s syndrome
Central lesions (4 Ss):
S – Stroke
S – Multiple Sclerosis
S – Swelling (tumours)
S – Syringomyelia (cyst in the spinal cord)
Pre-ganglionic lesions (4 Ts):
T – Tumour (Pancoast’s tumour)
T – Trauma
T – Thyroidectomy
T – Top rib (a cervical rib growing above the first rib above the clavicle)
Post-ganglionic lesion (4 Cs):
C – Carotid aneurysm
C – Carotid artery dissection
C – Cavernous sinus thrombosis
C – Cluster headache
What is a Holmes Adie Pupil?
A Holmes Adie pupil is a unilateral dilated pupil that is sluggish to react to light with slow dilation of the pupil following constriction
What is Holmes Adie syndrome?
Holmes Adie Syndrome is where there is a Holmes Adie pupil with absent ankle and knee reflexes.
Which condition is associated with Argyll Roberston pupil?
Neurosyphillis
