Random Flashcards
(12 cards)
Most common cause of nontraumatic pupil involving CN3 palsy
- PCOMM aneurysm
- parasympathetic fibers are externally located and affected
- usually painful
- up to 14% initially spare pupil
Aberrant regeneration of CN3 seen after what type of CN3 palsy?
-aneurysm or tumor
DDx of vertical diplopia?
-CN4 palsy, MG, thyroid, orbital disease, CN3 palsy, Brown’s syndrome, skew deviation, MS
Characteristics of bilateral CN4 palsy
RHT in LEFT gaze
LHT in RIGHT gaze
V pattern esotropia
>10 degrees of torsion
Surgical options of CN4 palsy
- SO tuck
- weaken ipsilateral IO
- weaken contralateral IR
- Harada-Ito: anterior and lateral displacement of SO to correct excyclotorsion
First-order neuron Horner’s syndrome
2nd order
3rd order
- 1st: hypothalamus to spinal cord
- 2nd: ciliospinal center of Budge to superior cervical ganglion (mediastinal or apical tumor)
- 3rd: superior cervical ganglion to iris dilator (ICA dissection, meckel’s cave or cavernous sinus lesions, trigeminal herpes zoster, headache syndromes, tumor of parotid, trauma)
Horner’s testing:
- Cocaine
- Hydroxyamphetamine
- Iopodine
- Cocaine: blocks reuptake of NE (no pupil dilation in Horner’s)
- Hydroxyamphetamine: releases NE from nerve terminal (preganglionic lesions have intact postganglionic neuron and thus pupil dilates; postganglionic lesions do not dilate because no NE released)
Treatment of ptosis in Horner’s
- shorten muller’s muscle
- Fasanella-Servat procedure: tarsoconjunctival resection
Paradoxical pupils
- optic nerve or retinal pathology
- CSNB, congenital achromatopsia, Bests, ADOA, LCA, albinism, RP
Optic nerve glioma
- Associated with?
- MRI findings
- NF
- fusiform thickening and kinking of ON
Optic nerve meningioma
-Pathology finding
- derived from arachnoid
- optociliary shunt vessels
- psammoma bodies
Bowtie optic disc pallor seen in what?
-optic tract lesion
