The eye in systemic disease Flashcards
What are the cardinal features of neurophthalmic disease?
- eye movement defects
2. visual defects
What is the gold standard imagine for identifying cause
MRI
Which secondary preventative measures should be taken?
BP and cholesterol
What does a IIIrd nerve palsy cause?
paralysis; medial rectus inferior rectus superior rectus inferior oblique sphincter pupillae levator palpebrae superioris
What will the ocular position be in a IIIrd nerve palsy?
down and out
What can cause a IIIrd nerve palsy?
-microvascular (more likely if it is pupil sparing) -tumour -aneurysm (especially if involving pupil= get MRI/angiogram) -MS -congenital
What will the ocular position be in a IVth nerve palsy?
eye sits higher and cannot turn inwards
What will the eye not be able to to with a trochlear nerve palsy?
Cannot squeeze downwards in adduction- eye will lift up as no intorsion
What compensation may be seen in a IVth nerve palsy?
Head tilt
What can cause a trochlear nerve palsy?
-congenital decompensated
-microvascular
-tumour
-bilateral-closed head trauma
longes cranial nerve- comes out posterior brainstem
What will be limited in a VIth nerve palsy?
Abduction of the globe
What muscular condition can cause VIth nerve palsy?
Myositis
What can cause a VIth nerve palsy
Microvascular
Raised ICP
Tumour
Congenital
Why is the abducens nerve susceptible to impingement?
When it passes over petrous tip
List the 3 main causes of CNIII palsy?
Vasculopathic
Tumour
Aneurysm
List the 4 main causes of CNIV palsy?
Vasculopathic
Tumour
Congenital
Trauma
List the 3 main causes of CNVI palsy?
Vasculopathic
Tumour
Cranial pressure
What is an inter-nuclear pathology?
Problem is in nucleus itself, problem with grey matter pathways and brainstem
What is seen in inter-nuclear pathology?
Eye coordination problems
Nystagmus
Describe nystagmus
still firing at nuclei level but eye doesn’t move
What are the causes of inter-nuclear pathology?
MS
Vascular
What is seen on MRI in MS?
Intensity at lateral ventricles = plaques= hallmark of MS
What is a supra-nuclear pathology?
Problem in frontal lobe or frontal eye field, initiation of eye movement is broken before it reaches nucleus
What can cause a optic nerve defect?
Ischaemic optic neuropathy
Optic neuritis
Tumours
What is optic neuritis
Commonly seen in MS
Progressive unilateral visual loss
Pain behind eye, on movement
Can cause atrophy
Central scotoma
Which tumours can cause an optic nerve defect?
Meningioma
Glioma
Haemangioma
What are the causes of a problem at the optic chiasm
Pituitary tumour
Craniopharyngioma
Meningioma
What can cause problems at the optic tract and radiations?
Tumours
Demyelination
Vascular anomalies
Where is the pathology in quadrantanopia?
Behind lateral geniculate
What do symmetrical defects suggest?
Problem towards the occipital lobe
