Scenarios Flashcards
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
loss of motion towards the lesion; MST damage
aka directional pursuit deficit
hemianopia where cannot see motion
MT damage, contralateral to defect
aka scotoma of motion
hemianopia where can see motion
normal, non-localizing
upward pursuit deficit
rostral NRTP
eye moves slower than the target (has to do catchup saccades) aka low gain pursuits
called cogwheel pursuits
associated w/ cerebellar dz
vertical pursuits
affected if damage in cerebellum or midbrain
saccades that are as slow as a pursuit
cerebellar dz
pursuits appear jerky, cerebellum is making poor calculations
loss of both vestibular and pursuit eye movements
cerebellar damage
pursuits that are asymmetric to the left and right
cerebral disease
reversal of slow OKN can occur
infantile nystagmus
vergence spasm in upgaze
possible pineal gland tumor, Parinaud’s syndrome
inability to look up and convergence-retraction nystagmus
Whipple disease; tx w/ sulfa-antibiotics
usually affects males
convergence induced w/ vertical saccades in a young patient
pinealoma
downbeat nystagmus convert to upbeat
in a MS pt who converges (Rx BO prism)
involuntary flutter
nystagmus secondary to a high fever
loss of adduction but convergence intact
INO d/t demyelination of MLF
retraction nystagmus
d/t pineal tumor
slow, irregular, low amplitude APN
amblyopia
high frequency, pendular, H–>V APN
infantile pendular nystagmus
nystagmus type that may be a transient finding in infants
upbeat nystagmus
present w/ alcohol, anticonvulsants, and sedatives
gaze-evoked nystagmus
R: large amplitude, low frequency
L: small amplitude, high frequency
Example of Brun’s nystagmus
is a right cerebellar pontine angle tumor
as soon as you attempt to do GAT, you notice a nystagmus on your patient!
latent nystagmus –> pathognomonic for anomalous correspondence
a 4 yr old w/ intermittent, fast, horizontal eye movements. Worse in aBducting eye. Worse w/ convergence
spasmus nutans
Other case hx: comorbid esotropia and amblyopia
Why would someone report a Anderson-Kestenbaum procedure in their case history?
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)
which EOM would Botox be injected into in cases of nystagmus?
acquired nystagmus in cases where nystagmus may be temporary (MS or stroke)
into the over-acting muscle; an off-label use, tx is transient
What are some of the risk/side effects of Botox?
keratitis, infection, transient ptosis, double vision, worse nyst. in non-injected eye
if a patient had a right head turn, which direction would yoked prism be used to relieve this head turn?
base toward the head turn (so the right)
A pregnant, epileptic patient with bipolar disorder also has APN. Are they a good fit for Valproate?
No. Valproate (Depakote) is a teratogen.
If the pt was male or not in child-bearing yrs, then this med could be considered
Left: lateropulsion, skew, Horner, facial numbness,
Right: loss of pain and temp sensation on extremities
bilatearl: vertigo and hiccups
left
A person has hypometric saccades to the left w/ Wallenberg syndrome. Which side is the lesion on?
right
worse contralesional
better ipsilesional
pt cannot look to their right. Where is the lesion?
right pons
MLF and CN6 (abducens nuclei)
ipsilateral horizontal gaze palsy
good saccades to the left, no saccades to the right. Pursuits and VOR intact
right (ipsilesional) One-Half syndrome in the PPRF
