Stroke !!!

Question 1

different VF tests for stroke

Answer 1

-confrontational VF if on stroke ward
-goldmann
-octopus
humphrey VF sita C30-2
-Binocular esterman on humphary for DVLA standard
(60-20 up, 20 down, 60, can t have more than 3 clusters in central 20 degrees)

Question 2

2 pen test

Answer 2

-hold 2 diff coloured pens and ask px what colour are the pens are. Homon heminopia will say one color then when told there’s another pen then will look around where it is but visual neglect wont look around will just say not there

Question 3

diff between visual inattention than visual neglect

Answer 3

VI is a lesser form of neglect , something may draw attention to it e.g. really bright flashing light

VN = compleltly unaware of that side

Question 4

visual neglect tests

Answer 4

• baloon test
  -line bisect
  -alberts
  -bells test, px asked to locate + circle all bells reflects px visual exploratory deficit
  -copying drawing- clock face px will only draw 1/2 of clock

Question 5

ways to assist stroke px

Answer 5

-repeated stimulation to border of visual field loss to restore it, so far only 5 degrees has worked
-signpost to rehab services
-yoked prisms and peli prisms (BI direction of defect)
-low vision aid or typographer to read
- adapting and scanning techniques, moving head to heminopia side
-advice, charles bonnet syndrome normal and when speaking to people stand on other side e.c.t. CBS = turn lights on to reduce
-relieve symptoms - diplopia, VF expand, reduce nformfortable AHP
-treat squint and convergence/accom problems
-monitor for recovery

Question 6

lesions and what VF defect

Answer 6

1. Optic Nerve = uniocular central scatoma
2. Optic Chiasm = biTEMPORAL hemianopia or ipsilateral nasal hemianopsia (if temporal)
3. Optic Tract= contralateral homonomyous hemianopia
4. Optic radiation = contralateral homonomyous quadrantinopia
5. occiptal cortex = contralateral homonymous hemianopia with macular sparing

Question 7

posterior circulation and visual causes

Answer 7

Vertebral arteries, basilar artery (midbrain & cerebellum supply), posterior cerebral artery, posterior communicating artery

Causes:
Isolated hemianopia
Cortical blindness
Disorders of conjugate gaze
Cranial nerve palsy

Question 8

other symptoms (not ocular) after stroke

Answer 8

Hemiplegia
Paralysis of one side of the body

Sensory problems
Cannot feel limbs

Cognitive problems
Mental processing
Perception
Communication:
Aphasia (language/speech problems)
Dyspraxia (co-ordination problems)
Dysarthria (speaking problems)

Emotional problems
Fatigue
Depression
anxiety

Question 9

Left hemishphere lesion will cause

Answer 9

LEFT HEMISPHERE
Right Hemiplegia
Right hemianopia
Right visual neglect
Aphasia (Recognise objects, can’t name)
Agnosia (Cannot interpret what is seen)
Visual agnosia

Question 10

right hemisphere lesion will cause

Answer 10

Left hemiplegia
Left Hemianopia
Left visual neglect
Hypometric Saccades to left
Abnormal smooth pursuits L to R
Reduced convergence
Reduced stereopsis
> Visual problems than L lesion

Question 11

visual conditions following a stroke

Answer 11

1. Visual field problems
   Hemianopia
   Reduced VA
2. Visual inattention/neglect
3. OM disorders
   Ocular muscle palsy
   Gaze palsy
   Nystagmus
   Reduced binocular functions
   Loss of depth perception
4. Visual perception disorders
   Cortical blindness
   Agnosia – cannot recognise objects
   Prosopagnosia – cannot recognise faces

Question 12

visual symptoms following a stroke

Answer 12

Diplopia
Oscillopsia
Bumping into things/tripping over
Blurred vision
Eye strain
Light sensitivity – very common (up to 90%)
Reading difficulty
Overcrowding/clutter
Sensitivity to peripheral motion
Depth perception