Ophthamology: Neuro-ophthamology Flashcards

1
Q

What is the first thing to assess in a patient with diplopia?

A

If it’s monocular or binocular

-binocular is more serious because it indicates a neuro issue.

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2
Q

Most common cause of monocular diplopia.

A

Astigmatism

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3
Q

Direction the eye deviates in CN III palsy.

A

Down and Out

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4
Q

Why is a blown pupil more emergent than impaired extraocular muscles in CN III palsies?

A

Blown pupil usually means an aneuysm compressing the nerve which can lead to a stroke or more severe condition. (occurs at the junction of the posterior communicating artery and internal carotid).

Impaired EOM is usually a diabetic infarct

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5
Q

What should you do in a patient with CN III palsy and a blown pupil? Without a blown pupil?

A

w/: Order and MRI and angiogram

w/o: Check blood sugar and blood pressure

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6
Q

Main cause of CN VI palsy.

A

Increased intracranial pressure that stretches the nerve. It exits the pons and runs along the floor of the skull up towards the cavernous sinus.

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7
Q

What is pseudotumor cerebri?

A

A neurological disorder that is characterized by increased intracranial pressure in the absence of a tumor or other diseases. Can lead to CN VI palsy.

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8
Q

How do patient’s present with injury to CN IV?

A

Head tilt opposite the side of the injured nerve.

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9
Q

Common causes of trochlear nerve palsy.

A

Trauma, ischemia, congenital defect, tumor

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10
Q

What is the number one reason that a CN is damaged due to a vascular incident?

A

Diabetes

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11
Q

What condition is associated with:

“diplopia that does not map to a specific cranial nerve”?

A

Myasthenia Gravis

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12
Q

The Tensilon Test is used to diagnose myasthenia gravis and is a dose of Edrophonium (AChase inhibitor). How would you treat an overdose of this indirect cholinergic agonist?

A

Atropine (cholinergic antagonist)

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13
Q

If a patient is diagnosed with myasthenia gravis, what should you also test them for?

A

Thymoma: check thryoid hormone levels

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14
Q

What is a cardinal sign of optic neuritis and what is it associated with?

A
  1. Loss of color vision
  2. Usually a demyelinating disease that is associated with increased RISK of Multiple Sclerosis……..only increased RISK
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15
Q

How do you treat optic neuritis?

A

IV steroids

oral steroids might further increase RISK of MS

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16
Q

What must be ruled out in patients over 55 with unilateral vision loss?

A

Giant Cell Ateritis (temporal arteritis)

17
Q

What two symtoms are indicative of Giant Cell Arteritis?

A
  1. Jaw Claudication

2. Scalp Tenderness

18
Q

What is the procedure for treatment if a physician suspects Giant Cell arteritis?

A
  1. Order sed. rate and CRP
  2. Temporal Artery Biopsy
  3. Start on steroids immediately (even before test results are back)
19
Q

Name and describe the 2 tests used to diagnose Horner Syndrome.

A
  1. Cocaine Test: block NE re-uptake. A Horner Syndrome patient will still show no effect on the bad eye but the normal eye will have mydriasis.

Paradrine Test: done after cocaine test. Inject hydroxyamphetamine, if the pupil doesn’t dilate it’s a lower motor neuron (3rd order) death.
If the pupil dilates, it’s a higher (1st or 2nd order) neuron issue.

20
Q

What should you check for in a patient with Horner Syndrome and pain?

A

Internal carotid dissection. MRI or angiogram.

21
Q

What is Adie’s Tonic Pupil?

A

Loss of parasympathetic innervation to the pupil. Pupil is dilated and won’t constrict.