Optic Neuropathies Part III

Question 1

Compressive optic neuropathy can have a progressive onset, vision loss and central VF involvement, dyschromatopsia, +/- ______, +/- optic nerve _____, +/- optic nerve ______

Answer 1

APD; edema; pallor

Question 2

You won’t see edema with _____

Answer 2

pallor; nerves have died off

Question 3

non neoplastic compressive optic neuropathy can deal with ____ eye disease, aneurysm due to _____, anterior cerebral artery, or ophthalmic artery aneurysm.

Answer 3

thyroid; ICA

Question 4

neoplastic compressive optic neuropathy can be intracranial due to:

Answer 4

1. sphenoid wing meningioma
2. pituitary adenoma
3. metastases

Question 5

neoplastic compressive optic neuropathy can also be involved with your optic nerve due to:

Answer 5

1. optic nerve sheath meningioma

2. optic nerve glioma

Question 6

optic nerve sheath meningioma is mainly in _____. F >M, seen in the fourth decade. It presents with _____ , optic nerve collateral vessels, and gradual VA loss

Answer 6

adults; pallor

treated with radiation therapy

Question 7

what two conditions cause shunt vessels

Answer 7

1. glaucoma

2. CRVO

Question 8

in neuroimaging, optic nerve meningioma presents with a train track appearance bc?

Answer 8

meninges are thickened by the tumor

Question 9

Optic nerve ______ is seen in children, usually seen before age ____, and 50% have _____.

Answer 9

glioma; 20; NFI

Question 10

what is NFI

Answer 10

genetic disorder due to nervous system tumor, most tumors are benign in children, but high mortality in adults.

Question 11

neurofibromas are _____ nerve tumors

Answer 11

peripheral

Question 12

optic nerve sheath meningioma think:

Answer 12

adults, collateral shunt vessels and ON pallor

Question 13

optic nerve glioma think:

Answer 13

kids, proptosis, NF1.

Question 14

glioma in adults you have to ________

Answer 14

neuroimaging.

Question 15

compressive optic neuropathy can also be due to _______ adenoma which is seen in mainly adults. F > M in the 4th or 5th decade. It is a slow growing epithelial tumor and can be due to ______

Answer 15

pituitary; hyperpituiatrism

Question 16

What can hyperpituitarism cause?

Answer 16

1. cushing syndrome due to excess ACTH: excessive cortison, moon face, big trunk,
2. acromegaly due to excess growth hormone; prominent brows, and jaw
3. prolactinoma: amenorrhea, galactorrhea, infertility, decreased libido
4. hyperthyroidism: goiter
5. Excess LH/FSH: precocious puberty in children and decreased libido in adults

Question 17

A ______optic neuropathy will usually be due to trauma and will cause a forceful backward dislocation of optic nerve from scleral canal bc of blunt force. Optic nerve avulsion will be ______

Answer 17

laminar; irreversible

Question 18

An _____orbital trauma will be due to a penetrating foreign body, displaced fracture or bone fragment, or compression by hematoma. What will it appear like?

Answer 18

intra orbital

usually direct injury to CRA and disc edema

In this case order a CT scan cause it will tell you if its in the orbit or globe and show hematomas.

Question 19

_______ trauma is the most common intracanalicular trauma. It occurs with/without fracture. Optic nerve appears normal initially but pallor develops _____weeks later, if its direct injury it will be from damage from bone fragments. Indirect injury is because of tearing of _____ blood vessels or shearing of axons or edema

Answer 19

Intracanalicular; 4-6; pial

Question 20

In a traumatic optic neuropathy VA will be typically poor immediately after trauma, and you will have a + _______as well as VF defects

Answer 20

RAPD

Question 21

Why is it useful to document VF defects in a traumatic optic neuropathy

Answer 21

return of vision or progression of VF loss

Question 22

how do you manage traumatic optic neuropathy

Answer 22

1. mega dose corticosteroids to decrease edema

2. optic nerve decompression done if there is continuous deterioration or no improvement in vision.

Question 23

What bacteria can cause infectious optic neuropathy

Answer 23

1. bartonella henselae: cat scratch
2. TB
3. Trepenoma pallidum (STD)
4. Lyme (tick bite)

Question 24

A fungal infection is usually rare but may be due to DM or immunocompromised patients (AIDS) - cryptococcal meningitis, or mucucormycosis which is extension of _____.

Answer 24

sinusitis

Question 25

A virus infection is due to:

Answer 25

1. HZV 2. Measles 3. Mumps 4. Chickenpox

Question 26

A parasitic infection is due to

Answer 26

1. toxoplasma | 2. toxocara

Question 27

If you have a swollen nerve with some exudates and sort of inflammation, that points to an _____

Answer 27

infection

Question 28

an infectios optic neuropathy presents with sudden or gradual (a few days) VA loss in one or both eyes. It may present with _____, lymphadenopathy, RAPD, macular edema, or anterior uveitis/vitritis/vasculitis, and swollen optic disc

Answer 28

fever

Question 29

Stellate ______usually deals with the macula and deals with inflammation of the nerve and retina.

Answer 29

neuroretinitis; star appearance around macula

Question 30

How do you manage a pt with infectious etiology

Answer 30

urgent referall to PCP for bloodwork. - CBC with differential - ESR (GCA) - CRP (GCA) - Bartonella henselae titers - Lyme titers - RPR-VDRL

Question 31

_______ optic neuropathy is usually painless, slowly progressive, bilateral, symmetric vision loss. VA ranges from 20/50 - _____. You will see characteristic VF loss and ONH pallor

Answer 31

nutritional; 20/200;

Question 32

Exam findings for nutrional optic neuropathy include ____ ONH pallor, centro cecal VF defects (extends from ONH to macula), dyschromatopsia, and no _____

Answer 32

temporal; RAPD (bilateral, and symmetric)

Question 33

Vitamin ____ must be ingested and converts carbs into glucose. Vitamin _____ helps with serotonin, norepineprine, and myelin formation. Vitamin ____ is critical for cell growth and metabolism. Vitamin ____ is critical for RBC formation and nerve function.

Answer 33

B1; B6, B9; B12

Question 34

Vitamin B12 deficiency is usually due to pernicious anemia which is due to decrease in RBC due to poor absorption of B12. It is an autoimmune condition. Neurologic symptoms include peripheral neuropathy, numbness, tingling ,and decreased deep tendon reflexes. B12 deficiency is also due to _____ surgery bc B12 absorption is imparied

Answer 34

GI

Question 35

With alcoholics, they have poor intake of B1 and B12, and poor absorption of it. Improves with _______Tobacco-alcohol amplyopia is ______ optic nerve toxicity

Answer 35

vitamin supplementation synergistic

Question 36

how do you manage nutritional optic neuropathy

Answer 36

1. Lab studies: CBC with differential, B1, B12, folate, RPR-VDRL, and Lyme 2. ERG to rule out rod/cone dsytrophy 3. B12 injections q1 mo x few months 4. multivitamin supplements.

Question 37

Toxic optic neuropathy can be due to medications, or ____ ingestion. Name some meds or toxic things

Answer 37

substance - Anti Tb meds: ethambutol, isoniazid - cancer chemotherapy agents -lead, methanol, tobacco

Question 38

______optic neuropathy is usually seen after treatment for ocular, sinus, intracranial and infraorbital malignancies. It is due to cumulative damage to _____cells and vascular _____ cells. It can occur after 3 years of radiation. No proven treatment, but steroids may help. HISTORY here becomes critical

Answer 38

Radiation; glial; endothelial

Question 39

Hereditary optic neuropathy can be autosomal dominant, autosomal recessive, ____ linked or mitochondrial

Answer 39

X

Question 40

_____ hereditary optic neuropathy is a _____ disorder which is contributed maternally. Begins at age ___-35

Answer 40

Lebers' mitochondrial; 25

Question 41

Leber's is acute severe vision loss in ____ eye. Fellow eye is involved in 2-4 weeks. It may be triggered by alcohol/tobacco abuse. VF loss will be central or ceco central scotoma. Optic nerve will initially be _____ then pale. There will be dilation of peripapillary retinal vessels and optic nerve does not leak on _____

Answer 41

one; hyperemic; FA

Question 42

Diff between Lebers and AION is that:

Answer 42

AION is within 24 hours/days, Lebers is within a couple of weeks. AION is pallid and its in older females. AION will leak on FA

Question 43

How do you manage Lebers

Answer 43

1. Rule out other causes by neuroimaging, lab tests 2. Genetic counseling once genetic mutation has been identified. 3. Electrocardiogram: may have associated cardiac conduction deficits. 4. Advised to limit tobacco and alcohol intake. 5. No FDA approved treatment. 6. Oral administration of idebenone. Enters brain to stimulate ATP formation in mitochondria. 7. Gene therapy

Question 44

Autosomal dominant Optic ATrophy is more common than Lebers, it is the most common inherited optic neuropathy and is also called Kjers Dominant Optic atrophy. It is ____ , symmetric, slowly progressive central VF loss. Vision abnormalities begin in childhood (4-10). VA ranges from 20/30 - ______. They will have a ____ color vision defect. They will present with NFL defect in _______ bundle

Answer 44

bilateral; 20/200; tritan; papillomacular

Question 45

The gene that encodes for mitochondrial gene, not the actual mitochondria is mutated in autosomal dominant optic atrophy. There is an equal prevalence in M and F. Treat with ____ ____ aids and prognosis is usually stable after adulthood

Answer 45

low vision