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VISIT TWO > 6.1.14 Assesses signs and symptoms of neurological significance. > Flashcards

6.1.14 Assesses signs and symptoms of neurological significance. Flashcards

1
Q

What are signs of ONH dysfunction?

A
  1. reduced VA in both near and distnace
    severe impaired CV
  2. RAPD
  3. VF defect
  4. impaired CS
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1
Q

what should a good neuro history have?

A
  1. normal h+s
  2. cheif complaint - degree, sveerity and duration
    v3. visual loss - bino/mono / dist /near
  3. dip / mono / binocular
  4. medical hist (meds, diseases, surgery)
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2
Q

what are the diffrences between macula / onh dysfunction?

A

ON = rapd macula = no cv = severe
onh = reduced brightness macula = augmented cv = mild for macula

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3
Q

what is optic neuritis?

A

inflmmation / demyelination of the ON - MS, TB , viral

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4
Q

why do you get rapid vision loss in optic neuritis?

A

Rapid vision loss : demylination / damage to the erve fibre layers = slowed transmission = loss of vision.

inflamm response : acute inflammatory response to the optic nerve –> signal distruptions

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5
Q

why do people with ms get optic neuritis?

A

Autoimmune attack –> immune attacks the CNS

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6
Q

why do you get ocular / retrobulbar pain with optic neuritis?

A

the optic nerve does not have any pain receptors but the shealth / tissues around it does
when inflammed these become more sensitive = pain when moving eyes

when the tissues in the orbit are inflammed = pain behind the eye

PAIN with eye movmeents

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7
Q

why does heat/ exercise increase visual loss in optic neuritis?

A

heat will temporarly breakdown the nerve signal transmission = conduction block = in a inflammed nerve the symptoms are more pronounce

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8
Q

why do you get RAPD in optic neuritis?

A

RAPD = asymmetry in the pupillary light reflex between the two eyes

optic neuritis = inflammation / demylination of the optic nerve = impaired tramission of visual signals to the brain

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9
Q

what will happen during RAPD?

A

when light is shone into the healthy eye, both will constrict as the afferent (incoming) pathway intact and normal efferent (outgoing) pathway.

when light is shone into the effected eye the response in both pupils is weaker+ slower as this optic nerve dose not transmit effectievly

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10
Q

D + C in optic neuritis?

A

SLOW for direct + consensual when shone into the effected eye

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11
Q

Swinging light test for optic neuritis?

A

when swinging to the effected eye , both eyes will appear dilated slightly –> reduction in the afferent signal from the affected eye

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12
Q

why do you get central scotoma with optic neurtis?

A

distruption of the signals from the central retinal region

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13
Q

why do you get severely imparied colour vision with ON?

A

The optic nerve has fibres which are sensitive to colour contrast .

cones are responsible for colour vision = high threshold response. == very sensitive to distruptions in signal tranmission –> inflmmation - impaired

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14
Q

why do you get blurry margins?

A

margins blurred as they are inlfmmated / swollen

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15
Q

why do you get swollen veins?

A

inflmmation around the disc = congestion = swelling of the viens = impedes the ormal venous outflow

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16
Q

what to do with ON?

A

emergency / urgent / steroids

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17
Q

What is Anterior ischaemic optic neuropathy? ANION

A

occlusion of the PCA - common in elderly people

ANION : assiocated with giant cell arteritis . Arteritic
NANION : atherosclerosis non- artertic

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18
Q

Why do you get HA with ANION?

A

Temporal arteries –> they become tender and inflamed. there are inflammed = manifest into a headache

ischemia –> inflmmation leads to narrow arteries -> reducd blood flow to the sclap and temples –> tissues become ischemic and = pain

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19
Q

what are systemic signs og GCA?

A
  1. jaw pain when chewing
  2. scalp/ temple tender
20
Q

Why do you get sudden / profound / permanent vision loss with Anterior ichemic optic neuropathy?

A

compromised blood flow to the optic nerve head - ischemia –> posterior ciliary arteries

Optic nerve head is sensitve to reduciton in blood flow because it is highly metabolic. _ ischmia = immedican vision loss

ischemia - infarction - damage to pathways from onh to hte brain

why permeant damage?
when axons are damaged due to the ischemia they have limted ability to regenerate

21
Q

why do you get an altitudianl defect -lower? with ANION + nANION

A

Specific pattern of the posterior ciliary arteries -> they divide into smaller branches –> the lower side is more vunerable then the upper / gravity

these defects are sudden –> acute

22
Q

why does the fundus become pale in ANION / NANION?

A

more temporal ; more vascular on this side .. pale = ischemia

23
Q

what is NAAION?

A

this is asscoiated with artiosclerosis

24
Q

how does artioscleriosis cause anion?

A

blood flow impairment -> does not meet the nerves metabolic needs.

risks are poor systemic health like HBP, diabetes , hyperlipidema and smoking.

25
Q

mechanism of artioscleriosis?

A

build up of plaques !
makes the ONH vunerable..

sudden pailess, vision loss VF defect lower altitudanl

26
Q

why is colour vision effected?

A

the optic nerve head has loads of diffrent fibres in. the colur vision fibre bundles appear to be vunerable to damage.

27
Q

What is papilloedma?

A

Swollen optic disc due to raised intracranial pressure - EMERGENCY

28
Q

why do you get headaches with papilloedma?

A

increased pressure stimulates the pain receptors in the membranes covering the brain and the spinal cord

Worse in the morning as a build of CSFluid at night when the body is horizontal + worse when bending over as this increases the pressure more

29
Q

Why you feel nausea with pap?

A

Increased Intracranial pressure = stimulate the VAGUS nerve = in charge of the digestive system –> sickness

Pressure in the medulla - vomiting reflex

30
Q

Normal / sudden blankning of vision in pap?

A

swollen –> but it can still funcition

Transient visual disturbances -> intermitten compression of the axons in the optic nerve head -> distrupts the slow of signals

31
Q

why do we get elevation to the ONH with ICP?

A

increased ICP = distrupted axoplasmic flow = swelling

32
Q

Why are the margins blurred?

A

fluid + swelling

33
Q

Why is the cup filled up?

A

the depressed cup fills up with fluid

34
Q

why does the retina and the choroid fold with pap?

A

due to the head swelling it causes mechanical compression + folding

35
Q

why do we get hyperamie at the disc with pap?

A

increased dilation of the vessels

36
Q

Why do we lose SVP with pap?

A

The ICP impede the the normal venous

37
Q

Why do we get heams at the disc?

A

increased pressure = stress on the small capillaries = ruptre

38
Q

Why do we get hard exudates with pap

A

increased icp = increased venous pressure = distruptes the blood-retinal barrier = leakage of lips+ proteins

39
Q

Why do we get cotton wool spots with pap?

A

ischemic areas due to the elevated ICP

40
Q

why do you get diplopia with pap?

A

It can initiate a 6th nerve palsy - affecting the abducens nerve which conteols the lateral rectus (moving the eye outwards)

ICP = strechs / compresses the abduceens nerve –> vunerable as it has a long path

because the eye cannot move outwards the affected eye may turn inwards (medically) casuign horizontal diplopia–> eyepatch prism

41
Q

why do you get halos with pap?

A

cornea + viterious humour changes //

retinal distortions –> the layers chnage alignment and this chnages the normal refractive index = light rays spread / diffract = halos around light sources

42
Q

what is stage one papilloedma?

A
  1. blurry OD margins
  2. Hyperaemia
  3. Los of SVP
    C shaped oedmea surround the disc
43
Q

grade 2 pap?

A

all of grade 1 + halo arround the OD

44
Q

Grade 3 pap

A

oedma coveres the BV as they leave the disc

45
Q

Grade 4

A

Covers the bv on the disc too

46
Q

What is chiasmial syndrome?

A

this is is mainly due to pit tumours

47
Q

what are visual feilds like with chiasmal syndromes?

A

they all respect the midline - pit = bitemporal hemianopia

48
Q

what does the parasympathetic innervation look like with pupillary reflexes?

A
  1. photoreceptor to the optic nerve
  2. optic nerve to the pretectal nucleus
  3. pretectal nucleus to the edinger-westphal nuclus
  4. edinger-westphal nuclsu to the pupil

VISIT TWO (17 decks)

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