Flashcards in Anisocoria +/- Ptosis Deck (55)
True or False. When you notice a anisocoria, you cannot have a ptosis?
False. In fact you look for the other as well
What muscles are affected by the Central nervous system?
Iris Dilator and Mueller's Muscle
What ocular structures are impacted by the parasympathetic system, to lids and pupils?
Levator and iris sphicnter
What is most common etiology of a true emergency?
True or False. All of CN3 is involved in a true emergency.
Anisocoria, Ptosis and diplopia when the lid is elevated.
What is usually the description of a headache when someone is entering with anisocoria with ptosis and diplopia?
Worst headache i've ever had
What do you look for when someone presents with a severe headache + diplopia?
Anisocoria + Ptosis
If a pt. comes in with acute onset of diplopia, what do you look for?
Anisocoria +ptosis + severe headache
For an acute onset emergency, how many of the three (diplopia, severe headache and anisocoria +ptosis) do you require to be considered an emergency?
2/3 or 3/3
What are the differential diagnosis of an emergency?
1. Aneurysm at the Circle of Willis
2. Rapid increase in size of intracranial mass
3. Rapid rise in intracranial pressure
e.g., ventricular or subarachnoid hemorrhage
4. Brainstem stroke
5. Cavernous sinus thrombosis, hemorrhage
What do you do, once you have concluded there is no emergency?
1.Anisocoria without ptosis
2.Anisocoria with ptosis
3. Ptosis alone
What is the true neurological test, which Mcnaughty thought was very powerful?
-Reaction to light
-Reaction to a near stimulus
-Pupil location - can change laterally
-Pupil shape - post surgery (cataract surgery - surgeon require good pupil dilation to conduct surgery)
What is the afferent ocuoloparasympathetic pathway impact the most?
What is the efferent ocuoloparasympathetic pathway impact the most?
When a signal is retrieve, what side of the pretectal nucleus will the information be relayed, when preforming a pupil test?
Describe the primary pathway of the oculosympathetic pathway?
1. Hypothalamus --> travels to the center of budge or stellate ganglion
2. Stellate ganglion to Superior cervial ganglion
3. Superior cervical ganglionSuperior orbital function (lid - muller and iris - radial)
Post ganglionic or tertiary pathway is based on what specific ganglion?
Superior Cervical Ganglion
A photopic loss indicates what type of lesion?
What type of lesion would be demonstrated if there is a Mesopic predominance?
What is the only lesion that has an equal mesopic and photopic dysfunction?
What region is affected when pupils are more likely to be equal than unequal?
What is the best test to conduct when observing pupil dysfunction?
What is the most common type of anisocira without ptosis?
When you want to see a long standing physiological anisocoria, what test are you conducting?
Familial album tomography (FAT) - look at photo albums and observe the presence of the pupil size
Note: You can do a cocaine test - negative
What is the ocular pathology you are looking for in the case of anisocoria without ptosis?
Atropine which is used for uveitis, she felt that it would help with red eye and used a red cap bottle
2.The usual suspects
-Iritis - inflammation will affect its ability to function
-Angle closure - iris muscles can become non-functional
You see that anisocoria without ptosis is more prominent in bright light, you then present Pilocarpine2 to 4%, you observe no miosis. What does this mean?
Note: Miosis usually occurs when there is normal functional of the iris
What is rule #1 when you see anisocoria?
Don't assume there is a neurological problem until you have ruled out:
2. Ocular pathology
3. Something directly affecting the muscles
What areas are within the orbit that are involved in the postganglionic parasympathetic system within the orbit?
Ciliary Ganglion, Iris sphincter and Iris dilator
What are the most common differential diagnosis of anisocoria without ptosis, when related to the postganglioic parasympathetic system?
1.Trauma affecting the ciliary ganglion