Scenarios

Question 1

Can see motion in one direction both inside and outside the hemianopia, but cannot see motion in the other direction (inside or out of the hemi)

Other info: saccades unaffected

Answer 1

loss of motion towards the lesion; MST damage

aka directional pursuit deficit

Question 2

hemianopia where cannot see motion

Answer 2

MT damage, contralateral to defect

aka scotoma of motion

Question 3

hemianopia where can see motion

Answer 3

normal, non-localizing

Question 4

upward pursuit deficit

Answer 4

rostral NRTP

Question 5

eye moves slower than the target (has to do catchup saccades) aka low gain pursuits

Answer 5

called cogwheel pursuits

associated w/ cerebellar dz

Question 6

vertical pursuits

Answer 6

affected if damage in cerebellum or midbrain

Question 7

saccades that are as slow as a pursuit

Answer 7

cerebellar dz

pursuits appear jerky, cerebellum is making poor calculations

Question 8

loss of both vestibular and pursuit eye movements

Answer 8

cerebellar damage

Question 9

pursuits that are asymmetric to the left and right

Answer 9

cerebral disease

Question 10

reversal of slow OKN can occur

Answer 10

infantile nystagmus

Question 11

vergence spasm in upgaze

Answer 11

possible pineal gland tumor, Parinaud’s syndrome

Question 12

inability to look up and convergence-retraction nystagmus

Answer 12

Whipple disease; tx w/ sulfa-antibiotics

usually affects males

Question 13

convergence induced w/ vertical saccades in a young patient

Answer 13

pinealoma

Question 14

downbeat nystagmus convert to upbeat

Answer 14

in a MS pt who converges (Rx BO prism)

Question 15

involuntary flutter

Answer 15

nystagmus secondary to a high fever

Question 16

loss of adduction but convergence intact

Answer 16

INO d/t demyelination of MLF

Question 17

retraction nystagmus

Answer 17

d/t pineal tumor

Question 18

slow, irregular, low amplitude APN

Answer 18

amblyopia

Question 19

high frequency, pendular, H–>V APN

Answer 19

infantile pendular nystagmus

Question 20

nystagmus type that may be a transient finding in infants

Answer 20

upbeat nystagmus

Question 21

present w/ alcohol, anticonvulsants, and sedatives

Answer 21

gaze-evoked nystagmus

Question 22

R: large amplitude, low frequency
L: small amplitude, high frequency

Answer 22

Example of Brun’s nystagmus

is a right cerebellar pontine angle tumor

Question 23

as soon as you attempt to do GAT, you notice a nystagmus on your patient!

Answer 23

latent nystagmus –> pathognomonic for anomalous correspondence

Question 24

a 4 yr old w/ intermittent, fast, horizontal eye movements. Worse in aBducting eye. Worse w/ convergence

Answer 24

spasmus nutans

Other case hx: comorbid esotropia and amblyopia

Question 25

Why would someone report a Anderson-Kestenbaum procedure in their case history?

Answer 25

resect horizontal rectus muscles to move the null position to primary gaze; success if mixed

Does not dampen nystagmus nor increase VA

Alternative: Four-muscle tenotomy (cut and reattach in exact same spot to reset the system)

Question 26

which EOM would Botox be injected into in cases of nystagmus?

Answer 26

acquired nystagmus in cases where nystagmus may be temporary (MS or stroke)

into the over-acting muscle; an off-label use, tx is transient

Question 27

What are some of the risk/side effects of Botox?

Answer 27

keratitis, infection, transient ptosis, double vision, worse nyst. in non-injected eye

Question 28

if a patient had a right head turn, which direction would yoked prism be used to relieve this head turn?

Answer 28

base toward the head turn (so the right)

Question 29

A pregnant, epileptic patient with bipolar disorder also has APN. Are they a good fit for Valproate?

Answer 29

No. Valproate (Depakote) is a teratogen.

If the pt was male or not in child-bearing yrs, then this med could be considered

Question 30

Left: lateropulsion, skew, Horner, facial numbness,
Right: loss of pain and temp sensation on extremities
bilatearl: vertigo and hiccups

Answer 30

left

Question 31

A person has hypometric saccades to the left w/ Wallenberg syndrome. Which side is the lesion on?

Answer 31

right

worse contralesional
better ipsilesional

Question 32

pt cannot look to their right. Where is the lesion?

Answer 32

right pons

MLF and CN6 (abducens nuclei)

ipsilateral horizontal gaze palsy

Question 33

good saccades to the left, no saccades to the right. Pursuits and VOR intact

Answer 33

right (ipsilesional) One-Half syndrome in the PPRF