Systemic disease- neurology

Question 1

How does neuro-opthalmic disease usually present?

Answer 1

Loss of visual acuity or field

Eye movement defects (may present as squint or diplopia)

Question 2

Which muscles are supplied by the 3rd, 4th and 6th cranial nerves?

Answer 2

Oculomotor- inferior oblique, medial, inferior and superior rectus
Trochlear- superior oblique
Abducens- lateral rectus

Question 3

How would 6th nerve palsy present?

Answer 3

Weakness of eye abduction on the affected side- eye may point medially/inwards when relaxed

Question 4

What condition might be considered with 6th nerve palsy and papilloedema?

Answer 4

Raised intracranial pressure compressing the abducens nerve

Question 5

What is the most common aetiology of 6th nerve palsy?

Answer 5

Microvascular pathology e.g. diabetes, hypertension

Question 6

What movements is the superior oblique muscle responsible for?

Answer 6

Intorsion
Depression from an adducted position
Weak abduction

Question 7

What clinical sign may indicate a 4th nerve palsy in a child?

Answer 7

Characteristic head tilt

Question 8

How does 4th nerve palsy present?

Answer 8

Diplopia

Question 9

What are the common causes of a 4th nerve palsy?

Answer 9

Congential (may present decompensated)
Microvascular
Tumour
Bilateral (closed head trauma)

Question 10

Other than the extra-ocular muscles, which muscles does the 3rd nerve supply?

Answer 10

Levator palpebrae superioris

Sphincter pupillae

Question 11

How does a 3rd nerve palsy present?

Answer 11

Ptosis, dilated pupil, eye “down and out”

Question 12

What might cause a painful 3rd nerve palsy?

Answer 12

Aneurysm

Question 13

What causes internuclear opthalmoplegia?

Answer 13

Disruption to the medial longitudinal fasciculus.

Causes- multiple sclerosis and other demyelinating diseases, vascular causes

Question 14

Which pathologies affect the optic nerve?

Answer 14

Ischaemic optic neuropathy
Optic neuritis (commonly MS)
Tumours (rarely)

Question 15

How do optic nerve defects affect visual field?

Answer 15

Are either complete, or abide the horizontal

Question 16

How does optic neuritis usually present?

Answer 16

Progressive visual loss
Pain "behind" eye especially on movement
Colour desaturation
Central scotoma
Gradual recovery

Question 17

How does optic chiasm pathology affect the visual field?

Answer 17

Bi-temporal field defects

Question 18

What kinds of diseases affect the optic chiasm?

Answer 18

Pituitary tumour
Craniopharyngioma
Meningioma

Question 19

How is the visual field affected in optic tract/radiation pathology?

Answer 19

Often homonomous defects
Macula isn’t spared
Sometimes see quadrantanopia
Incongruous patches of visual loss

Question 20

Which pathologies tend to affect the occipital cortex?

Answer 20

CVAs, demyelinating disease

Question 21

How do occipital cortex pathologies affect the visual field?

Answer 21

Homonomous defects
Spare the macula
Congruous