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Neurology eye (delta) Flashcards

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1
Q

Inferior obqlie action

A

Extorsion
Elevation
Abduction

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2
Q

Inferior rectus action

A

Depression

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3
Q

Medial rectus action

A

Adduction

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4
Q

Superior rectus action

A

Elevation

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5
Q

LPS action

A

Retraction of eyelid

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6
Q

Superior oblique action

A

Incyclotorsion
Depression
Abduction

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7
Q

Lateral rectus action

A

Abduction

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8
Q

CNs that originate from midbrain

A

Oculomotor

Trochelar

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9
Q

CNs that originate from pons

A

Trigeminal

Abducens

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10
Q

CNs at cerbellopontine angle

A

Facial nerve

Vestibulocochlear

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11
Q

CNs that originate at medulla

A

Glossopharyngeal
Vagus
Spinal accessory
Hypoglossal

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12
Q

Accomodation

A

Increase in lens curvature; ciliary muscle contracts leading to relaxation of suspensory ligaments of lens
Constriction of pupils; activation of sphincter pupillae
Eye convergence medially

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13
Q

Signs of optic nerve dysfunction

A 
Decrease in VA
Dyschromatopsia; red first
Visual field defects
Diminished contrast sensitivity 
RAPD
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14
Q

Systemic clinical features of MS

A

Sensory loss
Motor spinal cord symptoms
Autonomic; bladder, blower and sexual dysfunction
Cerebellar; tremor + dysarthria + ataxia
L’hermitte sign; electrical shock on neck flexion
Uhthoff phenomenon; worsening of symptoms due to increase in temperature

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15
Q

Opthalmic features of MS?

A

Optic neuritis; unilateral pain exacerbated by eye movement, decreased VA (central scotoma), dyschromatopsia, RAPD
INO
Nystagmus

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16
Q

What can be seen on ix for MS?

A

Demyelinated plaques on MRI

Oligoclonal bands in CSF on LP

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17
Q

Tx for optic neuritis

A

IV methylprednisolone followed by PO prednisolone

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18
Q

What is neuromyelitis optica?

A

Demyelinating disorder characterized by bilateral severe optic neuritis and transverse myelitis in 3 or more vertebral columns
Causes muscle weakness, increased tone and spasm

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19
Q

What can be seen on investigation of neuromyelitis optica?

A

IgG antibody against AQP4

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20
Q

What is AION?

A

Damage to optic nerve as a result of ischaemia

Can be non-arteritic or caused by giant cell arteritis

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21
Q

Presentation of non-arteritic AION

A

Less than 50
RF: idiopathic, hypertx, diabetes, sleep apnoea, disc anomaly
Occlusion of short posterior ciliary artery
Sudden, painless, unilateral visual loss
Inferior altitudinal VF defect
Disc swelling
Ix; BP, BG, exclude GCA
Treat cause

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22
Q

Presentation of GCA

A

Older than non-arteritic
GCS of short posterior ciliary artery
Sudden, painful, unilateral severe visual loss
Disc; chalky white, diffusely swollen, optic atrophy
Assoc sy; scalp tenderness, headache, jaw claudication
Ix; ESR, CRP, temporal artery biopsy
Tx; high dose IV methylprednisolone

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23
Q

What is papilloedema?

A

Optic disc swelling due to elevated ICP

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24
Q

Clinical features of papilloedema

A

Elevated ICP sy; headache (worse in morning), N+V, pulsatile tinnitus, deterioration of consciousness
Transient visual loss with a duration of seconds
Enlarged blind spot

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25
Signs of papilloedema on fundoscopy
Hyperaemia and blurring of disc margins | Swelling and elevation of optic disc with peripapillary sphincter haemorrhage
26
What is horner's syndrome?
Lesion to symp pathway
27
Hallmarks of horner's syndrome
Ptosis Miosis Ipsilateral anhydrosis
28
What causes horner's syndrome
``` Stroke Syringomyelia Pancoast tumour Carotid aneurysm ICA dissection Cluster headache Cavernous sinus lesion ```
29
What does a painful horner's syndrome direct you towards?
Carotid/ ICA dissection
30
What can be used to confirm hroner's syndrome?
Apraclonidine; will cause pupillary dilation in the horner's pupil but normal pupil will be unaffected
31
What is lateral medullary syndrome (wallenberg's syndrome)?
Ischaemia of lateral part of medulla due to blockage of posterior inferior cerebellar artery or vertebral artery
32
What are the clinical features of wallenberg's syndrome?
Damage to vestibular nucleus; vertigo, vomiting, nystagmus Damage to descending symp tract; ipsilateral horner's Damage to spinal trigeminal; ipsilateral loss of pain/temp and loss of corneal reflex Damage to spinothalamic tract; contralateral loss of pain/ temp in trunk and limbs Dysphagia Horseness
33
What is adie's pupil?
Loss of postganglionic parasymp innervation to iris sphincter and ciliary muscle
34
What are the clinical features of adie's pupil?
Dilation and blurring on near vision | Light reflex absent or slow
35
What is Holmes-Adie syndrome?
Diminished or absent deep tendon reflex of lower limbs + adie's pupil +/- orthostatic hypotension
36
Ix for Adie's pupil
Slit lamp | 0.125% topical pilocarpine. Adie's pupil will constrict while normal pupil won't
37
What causes argyll robertson pupil?
Neurosyphilis | Diabetes
38
What are the clinical features of argyll robertson pupil?
Bilateral, irregularly small pupils Will NOT react to light Normal accommodation
39
Will argyll robertson pupils constrict to 0.1% pilocarpine?
No
40
Causes of chiasmatic lesions?
Large pituitary adenomas Craniopharyngiomas Tuberculum sellae meningioma
41
What visual field defects will chiasmatic optic nerve cause?lesions
Bitemporal hemianopia
42
What will visual field defects will lesions at the optic tracts cause?
Contralateral homonymous hemianopia
43
What visual field defects will lesions at the optic radiations cause?
Temporal; contralateral superior homonymous quadrantanopia Parietal; contralateral inferior homonymous quadrantanopia Main radiations; contralateral homonymous hemianopia
44
What visual field defects will lesions at the occipital cortex cause?
Contralateral homonymous hemianopia with macular sparing | Congruous homonymous macular defects if posterior head injury
45
Features of 3rd nerve palsy?
Ptosis Abduction and depression with ophthalmoplegia Dilated pupil and accomodation abnormality
46
What causes a painful 3rd nerve palsy?
Posterior communicating artery anurysm
47
Causes of 3rd nerve palsy?
Diabetes and hypertex; affect blood supply to nerve Posterior communicating artery aneurysm (painful) Trauma Uncal herniation
48
What is weber's syndrome?
Stroke affecting ventral midbrain; characterised by ipsilateral 3rd nerve palsy with contralateral hemiapresis
49
What is benedikt's syndrome?
Form of stroke affecting dorsal midbrain characterised by ipsilateral 3rd nerve palsy with contralateral tremor, ataxia or chorea (red nucleus)
50
Clinical features of 4th nerve palsy?
Vertical diplopia Hypertropia Depression of eye is limited Compensatory head tily
51
Causes of 4th nerve palsy?
Congenital | Trauma
52
Clinical features of 6th nerve palsy
Horizontal double vision Esotropia in primary position Abduction limited
53
Causes of 6th nerve palsy?
Diabetes and hypertx | Increased ICP; abducens passes over petrous tip and so can easily be squashed by increased pressure
54
What is the pathology of myasthenia gravis?
Autoimmune disease of ACh receptors at post-synaptic NMJ
55
Clinical features of myasthenia gravis
``` Ptosis; bilateral Cogan lid twitch Diplopia Ophthalmoplegia Fragility and weakness or muscles of facial expression and proximal limb muscles ```
56
Ix for myasthenia gravis
Ice test; ptosis imrpvoes Antibodies; anti-ACh receptor antibody and MUSK antibody EMG and muscle biopsy Imagine of thorax for thymoma
57
Mx for myasthenia gravis?
Pyridostigmine Steroids Immunomodulators Surgery if thymoma present
58
Features of myotonic dystrophy
Delayed muscular relaxation and muscle wasting Early onset cataract Ptosis Hypermetropia
59
What causes myotonic dystrophy?
AD | Trinucleotide repeat on chromosome 19
60
Cause of NF1
AD | Mutation in NF1 gene on chromosome 17
61
Clinical features of NF1
Neurofibromas Cafe-au-lait spots Axillary freckling Ophthalmic features; optic nerve glioma, bilateral lisch nodules, plexiform neurofibromas of eyelid
62
Cause of NF2
Mutation in NF2 gene on chromosome 22
63
Features of NF2
Cataracts | Bilateral vestibular schwannoma
64
What is benign essential blepharospasm?
Bilateral idiopathic condition characterized by involuntary contraction of orbicularis oris muscle Presents in 6th decade Diagnosis of exclusion
65
Tx for benign essential blepharospasm
Artificial tears | Botulinum toxin injection
66
What is contained within the cavernous sinus?
ICA and CN6 pass directly through | Lateral walls; CN 3,4 and 5 (V1 and V2)
67
Clinical features of cavernous sinus syndrome?
Ptosis and ophthalmoplegia: compression of CN 3,4,6 Loss of corneal reflex: CN V1 Maxillary sensory loss Horner's syndrome; internal carotid ocular sympathetics Proptosis and periorbital swelling
68
What can cause cavernous sinus syndrome?
``` Infections Tumours Cavernous sinus thrombosis Internal carotid aneurysm Carotid-cavernous fistula ```

Neurology (48 decks)

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