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Year 2 > The eye in systemic disease (incomplete) > Flashcards

The eye in systemic disease (incomplete) Flashcards

1
Q

Where is the visual cortex found?

A

Occipital lobe

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2
Q

What are the two most important clinical features which suggest neuro-ophthalmic disease?

A

Eye movement defects

Visual defects

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3
Q

What symptom might a patient with eye movement defects describe?

A

Double vision

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4
Q

What are the causes of neuro-ophthalmic disease?

A 
Vascular disease
Space occupying lesions
Trauma
Demyelination
Inflammation/infection
Congenital
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5
Q

What is the most common cause of neuro-ophthalmic disease?

A

Vascular

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6
Q

How is suspected neuro-ophthalmic disease investigated?

A

Examination (ophtha + neuro)
Blood tests
MRI

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7
Q

What memory aid can be used to remember the cranial nerves supplying the eye?

A

LR6 (lateral rectus VI)
SO4 (superior oblique IV)
AO3 (all others III)

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8
Q

What does supra-nuclear refer to with respect to the brain?

A

Within the brain lobes (e.g supra-nuclear pathology)

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9
Q

What does intra-nuclear refer to with respect to the brain)

A

Between nerve nuclei

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10
Q

Which muscles control intorsion and extorsion?

A

Inferior and superior oblique

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11
Q

What muscle(s) is paralysed in a sixth nerve palsy?

A

Lateral rectus

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12
Q

What type of squint does a patient with sixth nerve palsy have? Why?

A

Esotropic (convergent)

The lateral rectus muscle is cannot perform abduction

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13
Q

What are the causes of sixth nerve palsy?

A

Microvascular (hypertension, diabetes)
Raised ICP
Tumour
Congenital

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14
Q

Microvascular causes of sixth nerve palsy usually resolve within a couple of months. T/F

A

True

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15
Q

How will sixth nerve palsy due to raised ICP present?

A

Sudden onset eye movement defect/double vision

Headache

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16
Q

Why does raised ICP cause compression of the sixth cranial nerve?

A

It runs over the petrous part of the temporal bone

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17
Q

Is papilloedema associated with sixth nerve palsy bilateral?

A

Yep

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18
Q

What is the most common cause of sixth nerve palsy?

A

Microvascular (2nd is raised ICP)

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19
Q

Which muscle(s) is paralysed in fourth cranial nerve palsy?

A

Superior oblique

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20
Q

Which movements does the superior oblique carry out?

A

Intorsion
Depression in adduction
Abduction (weak)

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21
Q

Which direction will an eye be looking with fourth nerve palsy?

A

Up and out

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22
Q

What sign will a patient with fourth nerve palsy characteristically have? Why?

A

Tilted head

Compensates for weak intorsion

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23
Q

What are the clinical signs of bilateral fourth nerve palsy?

A

Chin depressed

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24
Q

What is the cause of bilateral fourth nerve palsy? Why?

A 
Head trauma (closed)
Long intracranial course and thin easily stretched nerve
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25
Q

What are the causes of fourth nerve palsy? Which is most common?

A

Congenital (common)
Microvascular
Tumour
Head trauma

26
Q

Which is the least common cranial nerve palsy with reference to the nerves supplying eye movments?

A

Oculomotor (III) nerve palsy

27
Q

How does an eye with III nerve palsy appear?

A

Down and out
Ptosis
Mydriasis

28
Q

Which muscles are affected in III nerve palsy?

A 
Inferior oblique 
Medial rectus
Superior rectus
Inferior rectus
Sphincter pupillae 
Levator palpebrae superioris
29
Q

What are the causes of III nerve palsy?

A 
Microvascular
Tumour
Aneurysm 
Multiple sclerosis
Congenital
30
Q

What will be the cause of a painful III nerve palsy?

A

Aneurysm

31
Q

Do microvascular causes of III nerve palsy cause mydriasis? Do aneurysms?

A

Nah

Always

32
Q

What is inter-nuclear opthalmoplegia?

A

Impaired horizontal eye movement (weak adduction of affected eye and abduction nystagmus of unaffected eye)

33
Q

What is the most common cause of inter-nuclear opthalmoplegia?

A

Multiple sclerosis

2nd is vascular

34
Q

Working inter-nuclear pathways ensure that both eyes work in synchrony. T/F

A

True!

35
Q

Inter-nuclear opthalmoplegia arises from problems within which part of the brainstem?

A

Medial longitudinal fasciculus

36
Q

What is demyelination?

A

Damage to myelin insulator sheath surrounding nerves (known as white matter change)

37
Q

Describe the optic pathway

A 
Optic nerve -->
Optic chiasm -->
Optic tract -->
Optic radiation -->
Visual cortex
38
Q

What are the causes of pathology within the optic pathway?

A

Vascular (cerebrovascular accident)
Space occupying lesion
Demyelination (multiple sclerosis)
Trauma (surgical)

39
Q

Pathology with the left optic nerve will result in which visual field defect?

A

Complete loss of vision in left eye

Horizontal superior OR inferior loss of vision in left eye

40
Q

Pathology affecting the optic chiasm will result in which visual field defect?

A

Bitemporal hemianopsia

41
Q

Pathology affecting the left optic tract will result in which visual field defect?

A

Right sided hemianopsia

42
Q

Pathology affecting the occipital cortex will result in which visual field defect?

A

Homogenous hemianopsia

43
Q

Pathology affecting one of the optic radiations will result in which visual field defect?

A

Quadranopsia

44
Q

List pathologies which affect the optic nerve?

A

Ischaemic optic neuropathy
Optic neuritis
Tumours

45
Q

What is the most common cause of optic neuritis?

A

Multiple sclerosis

46
Q

What is optic neuritis?

A

Inflammation of the optic nerve

47
Q

List three tumours that can affect the optic nerve

A

Meningioma
Glioma
Haemangioma

48
Q

How does optic neuritis present?

A 
Progressive visual loss
Unilateral
Pain behind eye exacerbated by movement 
Colour desaturation 
Central scotoma
49
Q

How is optic neuritis managed?

A

Self resolving over weeks/months

50
Q

What might be seen on fundoscopy following optic neuritis?

A

Optic atrophy (pale, featureless disc)

51
Q

Haemangioma can cause which ocular symptoms? What is the most common cause?

A

Unilateral proptosis
Optic nerve compression (+ decreased vision)
Extraocular muscle restriction (+ eye movement defect –> diplopia)

Congenital

52
Q

Which pathologies affect the optic chiasm? Which of these affect children?

A

Pituitary tumour
Craniopharyngioma (children)
Meningioma

53
Q

How are visual defects caused by pituitary tumours managed?

A

Removal of tumour usually restores vision

54
Q

Which pathologies affect the optic tracts + radiations?

A

Tumours
Demyelination (multiple sclerosis)
Vascular abnormalities (AV malformation)

55
Q

With regards to defects within the optic tracts/radiations, is the macula spared?

A

Nope

56
Q

Can optic tract/radiation pathologies cause incongruous defects?

A

Yes!

57
Q

Which pathologies affect the occipital cortex?

A 
Vascular disease (cerebrovascular accident)
Demyelination (multiple sclerosis)
58
Q

Do pathologies affecting the occipital cortex result in macular sparing?

A

Yes!

59
Q

Can occipital cortex pathologies cause incongruous defects?

A

No - tend to be congruous

60
Q

A ring enhancing lesion on MRI tends to be characteristic of what?

A

Abscess (TB, parasites, chronic bacterial infection)

61
Q

Over which age is vascular disease the most common aetiology (in general) for neuro-opthalmic disease?

A

> 50

Year 2 (72 decks)

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