Neuro-phthalmology Flashcards
(45 cards)
Tell me about arteritic AION
https://www.reviewofophthalmology.com/CMSImagesContent/2010/10/1_14712_0.gif
- most often caused by GCA
- chalky white optic disc
- gradual headache and scalp tenderness, sudden vision loss
- do bloods (CRP/ ESR), temporal artery biopsy
- give steroids
Tell me about non-arteritic AION
- HTN and T2DM
- sudden headache and vision loss
- segmental hyperaemia of disc and splinter haemorrhages
- exclude GCA
- treat underlying cause
Leber hereditary optic neuropathy
mitochondiral
boys 10-30
Triad
1. Disc pseudo-oedema
2. peripapillary telangiectasia
3. Tortuosity of the medium sized retinal arterioles
- optic disc atrophy later
- centrocaecal scotoma
Ix - genetic testing and OCT (optic disc oedema or atrophy in late)
Nutritional optic neuropathy aka tobacco-alcohol amblyopia
causes:
- vitamin B, copper, folate deficiency
- medications e.g. amiodarone, ethambutol, sildenagil
- alcohol and smoking
Sx - gradual ↓ VA, cetrocaecal scotoma, dyschromatopsia
Papilloedema
- Hyperaemia and blurred margins
- Swelling and elevation of the whole optic disc with peripapillary haemorrhages
Features of raised ICP
- headache, worse in the morning ± vomiting
- pulsatile tinnitus
- unilateral or bilateral transient vision loss
- enlarged blind spot
- CN VI palsy
- Cushing reflex (bradycardia, bradypnoea, hypertension)
Optic disc coloboma
Defect in embryonic fissure closing
- Associated with Goldenhar syndrome
- Glistening white bowl excavation of optic disc (often in inferior part, hence superior visual field defect)
Morning glory anomaly
Congenital optic disc malformation
- funnel shaped excavation of optic disc
- vessels originate from periphery of optic disc
- retinal detachment
Optic nerve hypoplasia
- Double ring sign
RF: genetic disease, maternal smoking and alcohol and recreational drugs
Horner syndrome
- partial ptosis
- miosis
- anhydrosis (not present in 3rd order neurone lesion)
Causes of Horner syndrome
- primary neurone - lateral medullary lesion or syringomyelia
- secondary neurone - Pancoast tumour, neck trauma
- Tertriary neurone - internal carotid artery dissection (painful)
Horner syndrome investigations
- Topical apraclonidine - alpha 1 and 2 agonist -> dialation due to denervation hypersensitivity
- Topical cocaine - inhibits neuroadrenaline reuptake. MYDRIASIS IN NORMAL PEOPLE BUT NOT IN HORNER!!!
- Hydroxymethamphetamine - stimulates NA release from post-ganglionic neurone. Does not dialate in 3rd order neurone lesion
- TOPICAL ADRENALINE - MYDRIASIS 3»_space;»2 , 1
Holmes Adie pupil anisocria
Unilateral, dialated pupil
constricts in response to light and accommodation
Constriction in accommodation to near object»_space; light
cause: loss of postganglionic parasympathetic nerves to iris and ciliary muscle
Holmes Adie investigations
Slit lamp
Topical pilocarpine - constriction due to denervation hypersensitivity
Argyll Robertson anisocria
Bilateral irregular small pupils
No response to light
But constrict in accommodation (near object)
Cause: DM, neurosyphilis
Anterior chiasmatic lesion
Willebrand’s knee (inferonasal fibres)
Junctional scotoma: ipsilateral anopia + contralateral supratempral VF defect
cause: tuberculum sellae meningioma
Bitemporal superior quadranopia
pituitary adenoma
Bitemporal inferior quadranopia
Craniopharyngioma
Bitemporal hemianiopia
Pituitary adenoma
Craniopharyngioma
Large anterior communicating artery aneurysm
Binasal hemianopia
Bilateral internal carotid aneurysm
CN III palsy, pupil sparing
HTN and DM
Pupillomotor fibres are located superficially, supplied by pial blood vessels
CN III palsy, pupils involved
Pupillomotor fibres involved
Surgical, trauma, uncal hernication, posterior communicating artery aneurysm
Vascular syndromes of CNIII palsy
- Weber’s syndrome
- Benedikt syndrome
- Nothangel synrome
- Claude syndrome (Benedikt + Nothangel syndromes)
Weber’s syndrome
ipsilateral CNiii palsy
contralateral hemiparesis
