Lesions

Question 1

Causes of an optic nerve lesion

Answer 1

Papilloedema due to raised ICP

Optic neuritis

Question 2

Causes of raised ICP

Answer 2

SOL
Cerebral oedema
Infection
Hydrocephalus

Question 3

Clinical presentation of raised ICP optic nerve impingement

Answer 3

Visual changes on coughing / sneezing

Visual field defect

Question 4

Signs on fundoscopy of papilloedema

Answer 4

blurred disc margins
increased of cup to disc ratio
usually bilateral

Question 5

Causes of optic neuritis

Answer 5

MS

Infection - usually viral

Question 6

Clinical features of optic neuritis

Answer 6

Acute monocular vision loss
Eye pain on movement
Central scotoma
Relative afferent pupillary defect (dilation of pupil when light swings from unaffected eye to the affected eye)

Question 7

Causes of optic atrophy

Answer 7

Optic nerve compression - tumour
Raised ICP
Thiamine / B12 deficiency

Question 8

Presentation of optic atrophy

Answer 8

Reduced visual acuity
Central scotoma
Pallor of the disc on fundoscopy
RAPD

Question 9

Cavernous sinus pathology linked with which nerves?

Answer 9

3,4,5,6

Question 10

Presentation of CN 3 lesion

Answer 10

Eye turned down and out
Pupil dilated
Ptosis

Question 11

CN 4 innervates?

Answer 11

Superior oblique

Question 12

Lesion of CN4 presents as

Answer 12

diplopia on downwards gaze when the eye is adducted

Question 13

Causes of CN3 lesions

Answer 13

Vascular infarct
Trauma
DM
Cavernous sinus pathology

Question 14

Causes of CN4 lesions

Answer 14

Vascular infarct
Trauma
Cavernous sinus pathology

Question 15

3 branches of the trigeminal nerve

Answer 15

ophthalmic
maxillary
mandibular

Question 16

Trigeminal neuralgia presentation

Answer 16

sharp stabbing pain
usually in mandibular region
worse on washing / shaving / eating

Question 17

Treatment of trigeminal nerve

Answer 17

Carabamazepine - most effective

Question 18

Abducens nerve controls?

Answer 18

Lateral rectus nerve

Question 19

Presentation of CN6 nerve palsy

Answer 19

failure of abduction of the affected eye

diplopia on abduction of the affected eye

Question 20

Causes of CN6 nerve palsy

Answer 20

trauma
diabetes
vascular infarct
Cavernous sinus pathology

Question 21

Bells palsy definition

Answer 21

acute LMN facial nerve palsy (unknown origin)

Question 22

UMN lesion can cause what type of palsy

Answer 22

incomplete, just lower half of the face

due to duel supply from the cortex of the nerves innervating the upper face

Question 23

Causes of CN7 lesion

Answer 23

Bells palsy
Stroke
Infection - Ramsey Hunt (possible vesicles in the external auditory canal)
DM

Question 24

How quickly do Bells palsys usually recover

Answer 24

80% in 2m

Question 25

Causes of a CN8 lesion

Answer 25

``` Tumours MS Trauma Infection - meningitis Gentimicin ```

Question 26

Cause of menieres disease

Answer 26

Fluid overload due to failure of endolymph reabsorption

Question 27

Presentation of menieres disease

Answer 27

Episodic vertigo Fluctuating deafness Tinnitus Recurrent attacks

Question 28

Bulbar palsy definition

Answer 28

LMN lesion of 9,10,11 and 12

Question 29

Pseudobulbar palsy definition

Answer 29

UMN lesion of CN 9,10,112 and 12

Question 30

Causes of bulbar palsy

Answer 30

GB syndrome MN disease Tumour

Question 31

Pseudobulbar palsy causes

Answer 31

stroke MS MND

Question 32

causes of mixed UMN and LMN CN lesions

Answer 32

MND

Question 33

Presentation of bulbar palsy Speech Jaw jerk Gag reflex Tongue

Answer 33

``` Quiet and hoarse speech Absent jaw jerk Absent or reduced gag reflex Dysphagia Nasal regurg of food wasted tongue, flaccid w/ fasciculation's ```

Question 34

Presentation of pseudobulbar palsy Speech Jaw jerk Gag reflex Tongue

Answer 34

``` Slow monotonous speech Brisk jaw jerk Brisk gag reflex Dysphagia Small spastic tongue ``` May be UMN signs in the arms