Neuro-opthalmology

Question 1

What clinical signs would you see in a CNIII lesion?

Answer 1

The eye in a down and out position, ptosis, myadriasis

Question 2

What clinical signs would you see in a CNIV lesion?

Answer 2

Practically nothing, patient may have rotation of head away from lesion or complain of diplopia

Question 3

What clinical signs would you see in a CNVI lesion?

Answer 3

Affected eye is abducted (cross-eyes)

Question 4

What are some causes of monocular diplopia?

Answer 4

Astigmatism, cataracts, keratoconus, lens displacement

Question 5

What are some causes of binocular diplopia

Answer 5

Nerve palsys, Graves disease, mystenia gravis

Question 6

Describe the afferent pupillary pathway

Answer 6

Retina > optic nerve (CNII) > chiasm > optic tract > lat. geniculate nucleus > cortex

Question 7

Describe the efferent pupillary pathway

Answer 7

lat. geniculate nucleus > pretectal fibers > pretectal nucleus > Edinger-Westphal nucleus > oculomotor nerve (CNVIII)

Question 8

What two investigations should you order if someone has a blown pupil?

Answer 8

Angiogram and MRI

Question 9

What is a common cause of CNVI palsy?

Answer 9

Raised ICP

Question 10

What are 4 causes of CNIV palsy?

Answer 10

Trauma
Ischaemic
Congenital
Tumour

Question 11

What are the classic presentation of optic neuritis?

Answer 11

Young patient
Loss of central vision
Loss of colour vision
Worse with changes in body temp
Pain with eye movements

Question 12

What are some non ocular symptoms of GCA?

Answer 12

Scalp tenderness, jaw claudication, polymyalgia

Question 13

Name some causes for Horner’s Syndrome

Answer 13

Carotid dissection
Thyroid tumour
Pancoast tumour