Flashcards in Eyes Deck (17):
#1 - Diabetic patient presents with diplopia, worse at a distance. Diagnosis, physiology of diplopia, and prognosis?
Ischemic abducens palsy (common in longstanding poorly controlled diabetics). Changing from near to long distance requires slight abduction of eye requiring CN VI. Not a brainstem lesion, often isolated finding, and good prognosis.
#3 - Patient with progressively blurred vision. On exam, cannot see through to the retina. Diagnosis? Iatrogenic cause?
Posterior subcapsular cataracts. Happens with chronic steroid use
#4 - Primary headache syndrome with stronger association with men (hint, it’s the only one)
Cluster headaches. Can be associated with miosis (constricted pupil), anhidrosis, and ptosis (Horners)
#6 - Paramedian pontine perforating vessel stroke can cause what neurologic abnormality?
#7 - Painful loss of vision in one eye? (Pain with moving eye)
Optic neuritis (among other things). Fundoscopic exam will be normal an acute setting.
#8 - Elderly woman with joint and muscle pains diffusely presenting with recent onset blurred/lost vision? Diagnosis?
Polymyalgia rheumatica explains muscle aches and is associated with giant cell arteritis that can cause vision loss. Rx: high dose steroids, temporal artery biopsy
#9 - What is basilar migraine
More common in pediatric patients. Migraine with brainstem/cerebellar symptoms (dizziness, nausea, vomiting, confusion)
#10 - Sudden onset dilated pupil, drooping eyelid, slightly abducted eye. Diagnosis?
PCOM aneurysm compressing CN III
#11 - What eye abnormality is topomax (topiramate) associated with?
Angle closure glaucoma
Trochlear nerve palsy will leave the eye in which position?
Sightly elevated and adducted
#13 - localization of a left homonymous superior quadrant visual defect? Including name of the anatomical structure affected.
Lesion of right Meyers loop in the temporal lobe. This is a part of the optic radiations from LGN to primary visual cortex that subserves the upper portion of visual system
15 - significance of vision improving with pinhole testing?
Suggests vision problems are refractive or ocular and not neurological
18 - reversible posterior leukoencephalopathy syndrome. What is it, what causes it?
Encephalopathy of the occipital lobe. Occurs from immunosupressive drugs (tacrolimus, cyclosporine) used in transplant patients. Also occurs with chemotherapy drugs. Patients will exhibit cortical blindness with intact pupillary responses
#2- Elderly patient presents with anemia, severe headaches, and jaw pain with chewing or biting down?
Temporal arteritis. The key here is the anemia. Remember GCA causes systemic issues like anemia and also causes jaw claudication. It is also more common in older people. Don't be fooled by TMJ syndrome
3 difference between meningioma and GBM on imaging?
Meningioma is extra axial and uniformly enhances. GBM has heterogenous enhancement
4 - Key optho difference between a CN III palsy and a horners syndrome (ignoring extra ocular movements)?
Pupil dilation in CN III palsy from loss of parasymp (mydriasis), while constricted pupil in horners from loss of sympathetics (miosis)