CN & Neuro-ophtho

Question 1

cavernous sinus

Answer 1

CN III, IV, V1, V2, VI, ICA, sympathetics, optic chiasm

Question 2

superior orbital fissure
foramen Rotundum
foramen Ovale

Answer 2

“standing room only
SOF - CN III, IV, V1 , VI
Rotundum- CN V2
Ovale - CN V3

Question 3

jugular foramen
hypoglossal canal
foramen magnum

Answer 3

jugular forman - IX, X, XI
hypoglossal canal - CN XII
foramen magnum - meninges, vertebral As, medulla

Question 4

superior oblique

Answer 4

CN IV
Depression; Intorsion
closed head trauma

Question 5

inferior oblique

Answer 5

CN III
Extorsion externally rotates, elevates, and abducts

Question 6

inferior rectus

Answer 6

CN III-inferior branch
depresses and extorts

Question 7

eyelid innervation

Answer 7

orbicularis oculi - upper and lower eyelids - CN VII

CN III-oculomotor-levator palpebrae superioris -upper eye lid

Muller’s muscles/superior inferior tarus - sympathetic innervation - upper eyelid elevation and lower eyelid depression- 1-2mm

Question 8

Horner’s

Answer 8

1. ptosis upper eyelid - superior tarsal/Muller muscles
2. elevation lower eyelid - impaired depressed from inferior tarsal
3. miosis - impaired pupillodilator fxn
4. anhydrosis if dissection proximal to carotid bifurcation b/c sweating fibers in the ECA
5. Enophthalmos - decrease in palpebral fissure

Question 9

Leber optic neuropathy

Answer 9

mitochondrial disease

-“pseudo-edematous” optic nerve with peripapillary telangiectasia

-optic nerve heads - no leakage on fluoresein angiogram vs inflammatory cause

Tx: Idebenone - Raxone-antioxidant (mitochondrial electron carrier)

(no steroids/plex/IVIG)

Question 10

Optic neuritis infectious etiology

Answer 10

Bartonella cat scratch
Lyme
Syphillis

Question 11

Adie pupil

Answer 11

cause: damage to ciliary ganglion

-ciliary ganglion: most parasympathetic fibers contribute to near reflex, <5% to light reflex->will response to near response very slowly

-cholinergic hypersensitivity over time->diluted pilocarpine (0.125% , cholinergic) causes constriction when it wouldn’t in normal pupils

If non-dilute pilocarpine fails to constrict the pupil, then the pupil is pharmacologically dilated

syphilis - Argyle Robertson - no constriction to light but constrict to accommodation- symmetrically small, brisk response to near focus, sluggish react to light

Question 12

Horner’s

Answer 12

cocaine drops->prevent reuptake norepi; dilation normal pupil, no movement of Horner pupil

-if Horner’s ->worsening anisicoria after cocaine drops