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OD 3 - Neurological Disorders > Lectures 1 - 5 > Flashcards

Lectures 1 - 5 Flashcards

(70 cards)

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1
Q

What does gradual onset make you think?

A

Inherited or compressive

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2
Q

What does sudden onset make you think?

A

Ischemic, inflammatory or infectious

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3
Q

What does afferent mean?

A

Toward the brain

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4
Q

What does efferent mean?

A

Away from the brain

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5
Q

What age group do you think of when you are considering congenital lesions?

A

Children

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6
Q

What age group do you think of when you are considering degenerative or vasculopathic lesions?

A

Older adults

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7
Q

What age groups make you think of neoplastic disorders?

A

Children (Craniopharyngioma)

Adults (Pituitary Adenoma)

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8
Q

What are the critical components of a neuro-ophthalmic history? (10)

A 
CC
Detail the Problem
Temporal Profile of Symptoms
Associated Symptoms
Past Neurological History
Neurology Systems Review
Past Medical History
Family History
Social History
Special Considerations in Children (Pregnancy, Birth, Milestones)
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9
Q

When detailing the problem for afferent and efferent issues what are some unique questions you would ask to differentiate between the two?

A

Afferent: nasal, temporal, superior, inferior field of vision. Degree of loss.
Efferent Constant or Variable/Transient

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10
Q

What sort of disease process are you thinking of when the pattern of symptoms are described as acute w/ eventual plateau?

A

Vascular/Inflammatory

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11
Q

What sorts of disease processes are you thinking of when the pattern of symptoms is described as episodic?

A

Migraine, carotid disease, seizure disorder

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12
Q

What sort of disease process are you thinking when the degree of recovery is transient

A

Elevated ICP, vascular

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13
Q

What sort of disease process are you thinking when status gets worse over time then plateaus?

A

Inflammatory

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14
Q

What kind of recovery do you expect when a patient has a lesion due to ischemia?

A

Acute loss w/ little recovery

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15
Q

What kind of disease progression do you expect when your patient has a compressive lesion?

A

Gradual worsening

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16
Q

What are the major functions of the frontal lobe?

A

Primary motor cortex
Personality, behavior, emotion
Judgement, planning, problem solving
Intelligence, concentration, self-awareness
Broca’s area: expressive language
FEF: saccades, voluntary eye movement; communicates w/ EOMs via PPRF

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17
Q

What are the major functions of the parietal lobe?

A

Primary sensory cortex
Interpret visual and spatial information
Interpret language and words
Dominant lobe (left): calculation, writing, left-right orientation, finger recognition
Non-dominant lobe: integrates contralateral side of body with environment (left sided neglect)
Connect somatosensory, auditory and visual input

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18
Q

What are the major functions of the temporal lobe?

A

Understanding language (Wernicke’s speech area), hearing, memory

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19
Q

What is the major function of the occipital lobe?

A

Vision

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20
Q

What percentage of the total neurons in the brain pass through the cerebellum?

A

50%

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21
Q

What are the major parts of the diencephalon?

A

Thalamus & Hypothalamus

& the pineal gland

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22
Q

What nuclei are contained in the midbrain?

A

CN III and CN IV

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23
Q

What sensory and motor nuclei lie within the pons?

A

CN V, VI, VII, & VIII

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24
Q

What are the major components of the sympathetic nervous system pertaining to vision?

A

Any lesion to the sympathetic chain will affect your ability to dilate.
Pre-ganglionic : T1-2
Synapse: Cervical Sympathetic Ganglia
Postganglionics: Peri-arterial plexus along ICA and ECA

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25
What are the major components of the parasympathetic nervous system pertaining to vision?
Preganglionics: CN III, VII (& IX, X) Synapse: 4 cranial ganglia (ciliary & pterygopalatine) or directly on target glands Postganglionics (Distributed via branches of CN V)
26
Describe the anatomy of CN I.
Olfactory Nerve Not a true nerve exits cranium via perforation in the cribriform plate Special afferent fibers only
27
Describe the anatomy of CN II.
``` Optic Nerve Not a true nerve Exits cranial cavity via optic canal Carries axons of ganglion cells in the retina Special afferent fibers only ```
28
Describe the anatomy of CN III.
Oculomotor Nerve Exits cranial cavity via superior orbital fissure Mixed cranial nerve (GE & VE)
29
Describe the anatomy of CN IV.
Trochlear Innervates superior oblique Originates in dorsal aspect of midbrain (on CN to cross over) Exits cranial cavity via superior orbital fissure General efferent only
30
Describe the anatomy of CN V.
Trigeminal Mostly sensory Some GSE fibers Suspends 4 sympathetic ganglia (ciliary, pterygopalatine, otic, submandibular) Carries hitchhiking fibers Exits from the Pons 3 Divisions (Ophthalmic, maxillary, mandibular)
31
Describe the anatomy of CN VI.
Abducens Innervates lateral rectus Exits brainstem at junction of pons and medulla Exits cranial cavity via superior orbital fissure General efferent only
32
Describe the anatomy of CN VII.
Facial Nerve GE, VE, SA (ant. 1/3rd of tongue) Longest intraosseous course
33
Describe the anatomy of CN VIII.
Vestibulocochlear Leaves brainstem lateral to CN VII at CPA Exits cranial cavity through internal acoustic meatus Does not leave the skull Innervates inner ear structures Special afferent fibers only
34
Describe the anatomy of CN IX.
Glossopharyngeal Leaves brainstem from lateral aspect of upper medulla Exits cranial cavity via jugular foramen VE, VA, GA (post 1/3rd of tongue)
35
Describe the anatomy of CN X.
Vagus Leaves brainstem lateral to CN IX in the upper medulla Exits cranial cavity via jugular foramen GE, VE (to all organs below neck minus adrenal)
36
Describe the anatomy of CN XI.
Spinal Accessory Nerve Innervates trapezius & sternocleidomastoid GE only Originates outside the skull in the upper spinal cord between C1 and C5 Enters skull via foramen magnum, exits skull via jugular foramen
37
Describe the anatomy of CN XII.
Hypoglossal Innervates the tongue Leaves the cranial cavity via hypoglossal canal in the occipital bone GE only
38
What are the critical components of the neuro-ophthalmic exam for the afferent visual system?
VA Contrast Sensitivity Color Vision VF
39
What are the critical components of the neuro-ophthalmic exam for the efferent visual system?
Pupils Eyelids EOMs Facial Nerve Function
40
How do you test CN I (Olfactory Nerve)?
Test each nostril separately with coffee or perfume
41
How do you test CN II (Optic Nerve)?
VA, color vision, VF, pupils
42
How do you test CN III (Oculomotor Nerve)?
EOMs (SR, MR, IR, IO, LPS), pupils
43
How do you test CN IV (Trochlear)?
EOMs (SO)
44
How do you test CN V (trigeminal)?
Sensory: facial sensation in each area, corneal blink reflex Motor: ask pt to clench teeth while you palpate master and pterygoid, have patient move jaw against resistance from your hand
45
How do you test CN VI (Abducens)?
EOMs (LR)
46
How do you test CN VII (facial)?
Motor: eyelid closure, forehead wrinkling, smiling, cheek puffing, whistling Lacrimation: Shirmer Testing Taste
47
How do you test CN VIII (Vestibulocochlear)?
White Noise Tests (Rinne Test, Weber Test)
48
How do you test CN XI (Spinal Accessory Nerve)?
Head and shoulder elevation
49
How do you test CN IX (Glossopharyngeal) and X (Vagus)?
Check gag reflex
50
How do you test CN XII (Hypoglossal)?
Tongue protrusion (lick the wound)
51
What are the key components of a neurological exam?
Mental Status Evaluation Cranial Nerve Assessment Examination of Arms and Legs
52
What does the hill of vision?
As you get closer and closer to the fovea from the periphery your sensitivity increases until you reach the peak at the center of the fovea
53
Where is the physiological blind spot?
15 degrees temporal to point of fixation, 1.5 degrees below the horizontal meridian
54
In what type of perimetry do patients with neurological diseases tend to do better at?
Kinetic perimetry (octopus)
55
What other part of the visual pathway will be involved when a pituitary tumor pushes on a pre-fixed chiasm?
Optic tract first
56
What other part of the visual pathway will be involved when a pituitary tumor pushes on a post-fixed chiasm?
Optic nerve first
57
What is the visual pathway extending from the retina to the occipital cortex?
Retinal ganglion cells > Optic nerve > Optic chasm > Optic tract > Lateral Geniculate Body > Optic Radiations > Visual Cortex
58
What does a depression in a VF mean?
Generalized reduction in retinal sensitivity
59
What does a scotoma mean?
A focal area of reduced sensitivity surrounded by an area of normal sensitivity
60
What are the patterns of VF loss when there is a lesion to the optic nerve?
Central, centro-cecal, arcuate, altitudinal, enlarged blind spot, diffuse
61
What kind of VF loss do you expect with Anterior Chiasmal Syndrome?
Ipsilateral central scotoma, contralateral superior temporal defect
62
What kind of VF loss do you expect with Posterior Chiasmal Syndrome?
Central bitemporal hemianopia defects (nasal macular fibers)
63
What kind of VF defect do you expect with Middle Chiasmal Syndrome?
Bitemporal hemianopia, bilateral optic atrophy
64
What kind of VF defect do you expect with Lateral Chiasmal Lesion?
Binasal hemianopia, bilateral optic atrophy
65
What kind of VF defect do you expect to find with an optic tract lesion?
Congruous hemianopia
66
What kind of VF defect do you expect to find with a Lesion of the Optic Radiations?
Incomplete incongruous quadranopsia but neurological deficits predominate
67
What kind of VF defect do you expect to find with a temporal lobe lesion?
Pie in the Sky
68
What kind of VF defect do you expect to find with a parietal lobe defect?
Pie in the floor
69
What kind of VF defect do you expect to find with a middle cerebral artery infarct to the visual cortex?
Congruous homonymous hemianopia with macular sparing
70
What kind of VF defect do you expect to find with a posterior cerebral artery infarct to the visual cortex?
Congruous homonymous macular defect

OD 3 - Neurological Disorders (2 decks)

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