Neuro Ophthalmology 1

Question 1

Where is early papillaedema first apparent?

Answer 1

Inferior and superior fields

Question 2

What percentage of the general population exhibit spontaneous venous pulsations?

Answer 2

80%

Question 3

What neurological findings can be found in idiopathic intracranial hypertension?

Answer 3

CN VI, other neurological deficits are not found except in juvenile IIH

Question 4

What is the etiology of naion?

Answer 4

Presumably compromised micro circulation in discs at risk

Question 5

What is the 5 year risk of contalateral involvement in naion?

Answer 5

15%

Question 6

What is pseudo-foster Kennedy syndrome?

Answer 6

Contralateral involvement of naion which shows disc edema while the initial naion eye shows atrophy/palor

Question 7

What layers of the lgb receive uncrossed fibers?

Answer 7

2, 3, 5

Question 8

“Pie in the sky” VF defect is caused by injury to what fibers?

Answer 8

Meyers loop (temporal fibers)

Question 9

Object agnosia

Answer 9

Inability to recognize objects. Localizes to bilateral occipitotemporal (ventral pathway) dysfunction.

Question 10

Prosopagnosia

Answer 10

Inability to recognize faces. Localizes to bilateral occipital lobe. Seen in patients with Alzheimer’s.

Question 11

Akinetopsia

Answer 11

Loss of perception of motion

Question 12

Alexia without agraphia

Answer 12

Can’t read but can write, disruption between occipital lobe and the dominant angular gyrus

Question 13

Simultanagnosia

Answer 13

Inability to see several events in a scene and integrate a total picture/scene

Question 14

Balint syndrome

Answer 14

Injury to bilateral occipitoparietal lobes resulting in triad of simutanagnosia, optic ataxia, oculomotor apraxia

Question 15

Anton syndrome

Answer 15

Denying visual deficits when in fact cortical blindness is reality.

Question 16

Riddoch phenomenon

Answer 16

Preservation of the perception kinetic but not static vision. Portends a better outcome. Also termed staticokinetic dissociation.

Question 17

When evaluating anisicoria, what other parts of the ocular exam should you pay close attention to?

Answer 17

Eom and lid position (for cn 3 involvement)

Question 18

Tadpole pupil

Answer 18

Focal spasm of iris dilator muscle causing a peaking of the pupil lasting minutes occurring numerous times intermittently. May harbor

Question 19

Midbrain corectopia

Answer 19

Eccentric or oval pupils from rostral midbrain disease.

Question 20

What is the gtt sequence used in testing for a horners pupil?

Answer 20

1. Apply 10% cocaine and anisicoria will increase (miotic horners pupil does not dilate well)OrApply 1 or 5% apraclonidine and see reversal of miotic versus dilated pupil2. >24 hours later apply paredrine (hydroxyamphetamine) to decipher which order neuron

Question 21

What is the differential for anisicoria greater in dark? (Abnormally small pupil)

Answer 21

Pharmocoligic, inflammatory (synechia binds down), horners, chronic adies, argyll Robertson (although always bilateral)

Question 22

What is the differential for anisicoria greater in the light (abnormal pupil is large)?

Answer 22

Iris sphincter tear, physiologic, 3rd nerve palsy, adies, pharmocologic,

Question 23

What are other ophthalmic signs of horners syndrome besides the classic triad?

Answer 23

1. Lower iop on affected side2. Conjunctival hyperemia (decreased sympathetic vascular tone)3. Iris heterochromia (congenital horners)4. Transient increase in accommodation (older patients hold the near card closer on the affected eye.

Question 24

Are argyll Robertson pupils always bilateral?

Answer 24

Yes, although may be asymmetric

Question 25

What is a basic differential for light-near dissociation?

Answer 25

Bilateral optic neuropathy or severe retinopathyArgyl Robertson pupilsAdies tonic pupilsDorsal midbrain (paranauds) syndromeDiabetes, alcoholismAberrant 3rd nerve regeneration

Question 26

The saccadic system generates eye movements how fast? Smooth pursuit system?

Answer 26

400-500 degrees/sec; 30-60 degrees/sec

Question 27

What is the active forced generation test?

Answer 27

Patient is asked to look in a directin against force of an instrument grasping,

Question 28

Congenital ocular motor apraxia is characterized by….

Answer 28

Absence or defect in controlled, purposeful, and voluntary eye movementpatients must turn their heads to seeno nystagmus induced on okn drum testing horizontally

Question 29

At what point should a patient with optic neuritis start to demonstrate vision improvement?

Answer 29

1 month. If no improvement or worsening nmo should be considered

Question 30

What is the diagnostic criteria for NMO?

Answer 30

-Optic neuritis-Myelitis-2 of the following1. Spinal cord lesion spanning >3 vertebral segments2. MRI brain non-diagnostic for ms3. Nmo IgG positive

Question 31

What is a good way to differentiate skew vs superior oblique palsies that have similar appearing deviation patterns?

Answer 31

There is in torsion in skew deviation vs ex torsion in superior oblique palsy

Question 32

Excyclotorsion of how much suggests bilateral superior oblique palsy?

Answer 32

More than 10 PD

Question 33

What AHP (abnormal head position) would someone with bl so palsy show?

Answer 33

Chin down (doesn’t make sense to me bc there is a V pattern deviation)

Question 34

What percentage of the visual cortex is devoted to macular fibers?

Answer 34

80%

Question 35

The occipitotemporal pathway is also called the “what” or “where” pathway? Is it ventral or dorsal? How about the occipitoparietal pathway?

Answer 35

“what” pathway which is ventral; “where” pathway which is dorsal

Question 36

Ocilopsia would localize to failure of which of the 6 eye movement pathways?

Answer 36

Vestibular

Question 37

What is the purpose of the optokinetic pathway?

Answer 37

To track full field visual motion

Question 38

There are two main categories of brainstem saccade generators, the horizontal saccades and the vertical saccades. Where do the exitatory neurons originate for the horzontal and vertical saccades respectively?

Answer 38

Horizontal: PPRF (paramedian pontine reticular formation)Veritcal: riMLF (rostral interstitial nucleus of the medial longitudinal fasiculus)

Question 39

Does upward saccadic exitatory stimulation project bilateral or ipsilateral from the riMLF? Downward?

Answer 39

bilateral; ipsilateral

Question 40

Which center coordinates vergence movements?

Answer 40

MRF (midbrain reticular formation) premotor neurons project to CN nuclear complex to stimulate the near triad