The eye in systemic disease (incomplete) Flashcards Preview

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Flashcards in The eye in systemic disease (incomplete) Deck (61):
1

Where is the visual cortex found?

Occipital lobe

2

What are the two most important clinical features which suggest neuro-ophthalmic disease?

Eye movement defects
Visual defects

3

What symptom might a patient with eye movement defects describe?

Double vision

4

What are the causes of neuro-ophthalmic disease?

Vascular disease
Space occupying lesions
Trauma
Demyelination
Inflammation/infection
Congenital

5

What is the most common cause of neuro-ophthalmic disease?

Vascular

6

How is suspected neuro-ophthalmic disease investigated?

Examination (ophtha + neuro)
Blood tests
MRI

7

What memory aid can be used to remember the cranial nerves supplying the eye?

LR6 (lateral rectus VI)
SO4 (superior oblique IV)
AO3 (all others III)

8

What does supra-nuclear refer to with respect to the brain?

Within the brain lobes (e.g supra-nuclear pathology)

9

What does intra-nuclear refer to with respect to the brain)

Between nerve nuclei

10

Which muscles control intorsion and extorsion?

Inferior and superior oblique

11

What muscle(s) is paralysed in a sixth nerve palsy?

Lateral rectus

12

What type of squint does a patient with sixth nerve palsy have? Why?

Esotropic (convergent)
The lateral rectus muscle is cannot perform abduction

13

What are the causes of sixth nerve palsy?

Microvascular (hypertension, diabetes)
Raised ICP
Tumour
Congenital

14

Microvascular causes of sixth nerve palsy usually resolve within a couple of months. T/F

True

15

How will sixth nerve palsy due to raised ICP present?

Sudden onset eye movement defect/double vision
Headache

16

Why does raised ICP cause compression of the sixth cranial nerve?

It runs over the petrous part of the temporal bone

17

Is papilloedema associated with sixth nerve palsy bilateral?

Yep

18

What is the most common cause of sixth nerve palsy?

Microvascular (2nd is raised ICP)

19

Which muscle(s) is paralysed in fourth cranial nerve palsy?

Superior oblique

20

Which movements does the superior oblique carry out?

Intorsion
Depression in adduction
Abduction (weak)

21

Which direction will an eye be looking with fourth nerve palsy?

Up and out

22

What sign will a patient with fourth nerve palsy characteristically have? Why?

Tilted head
Compensates for weak intorsion

23

What are the clinical signs of bilateral fourth nerve palsy?

Chin depressed

24

What is the cause of bilateral fourth nerve palsy? Why?

Head trauma (closed)
Long intracranial course and thin easily stretched nerve

25

What are the causes of fourth nerve palsy? Which is most common?

Congenital (common)
Microvascular
Tumour
Head trauma

26

Which is the least common cranial nerve palsy with reference to the nerves supplying eye movments?

Oculomotor (III) nerve palsy

27

How does an eye with III nerve palsy appear?

Down and out
Ptosis
Mydriasis

28

Which muscles are affected in III nerve palsy?

Inferior oblique
Medial rectus
Superior rectus
Inferior rectus
Sphincter pupillae
Levator palpebrae superioris

29

What are the causes of III nerve palsy?

Microvascular
Tumour
Aneurysm
Multiple sclerosis
Congenital

30

What will be the cause of a painful III nerve palsy?

Aneurysm

31

Do microvascular causes of III nerve palsy cause mydriasis? Do aneurysms?

Nah
Always

32

What is inter-nuclear opthalmoplegia?

Impaired horizontal eye movement (weak adduction of affected eye and abduction nystagmus of unaffected eye)

33

What is the most common cause of inter-nuclear opthalmoplegia?

Multiple sclerosis
(2nd is vascular)

34

Working inter-nuclear pathways ensure that both eyes work in synchrony. T/F

True!

35

Inter-nuclear opthalmoplegia arises from problems within which part of the brainstem?

Medial longitudinal fasciculus

36

What is demyelination?

Damage to myelin insulator sheath surrounding nerves (known as white matter change)

37

Describe the optic pathway

Optic nerve -->
Optic chiasm -->
Optic tract -->
Optic radiation -->
Visual cortex

38

What are the causes of pathology within the optic pathway?

Vascular (cerebrovascular accident)
Space occupying lesion
Demyelination (multiple sclerosis)
Trauma (surgical)

39

Pathology with the left optic nerve will result in which visual field defect?

Complete loss of vision in left eye
Horizontal superior OR inferior loss of vision in left eye

40

Pathology affecting the optic chiasm will result in which visual field defect?

Bitemporal hemianopsia

41

Pathology affecting the left optic tract will result in which visual field defect?

Right sided hemianopsia

42

Pathology affecting the occipital cortex will result in which visual field defect?

Homogenous hemianopsia

43

Pathology affecting one of the optic radiations will result in which visual field defect?

Quadranopsia

44

List pathologies which affect the optic nerve?

Ischaemic optic neuropathy
Optic neuritis
Tumours

45

What is the most common cause of optic neuritis?

Multiple sclerosis

46

What is optic neuritis?

Inflammation of the optic nerve

47

List three tumours that can affect the optic nerve

Meningioma
Glioma
Haemangioma

48

How does optic neuritis present?

Progressive visual loss
Unilateral
Pain behind eye exacerbated by movement
Colour desaturation
Central scotoma

49

How is optic neuritis managed?

Self resolving over weeks/months

50

What might be seen on fundoscopy following optic neuritis?

Optic atrophy (pale, featureless disc)

51

Haemangioma can cause which ocular symptoms? What is the most common cause?

Unilateral proptosis
Optic nerve compression (+ decreased vision)
Extraocular muscle restriction (+ eye movement defect --> diplopia)

Congenital

52

Which pathologies affect the optic chiasm? Which of these affect children?

Pituitary tumour
Craniopharyngioma (children)
Meningioma

53

How are visual defects caused by pituitary tumours managed?

Removal of tumour usually restores vision

54

Which pathologies affect the optic tracts + radiations?

Tumours
Demyelination (multiple sclerosis)
Vascular abnormalities (AV malformation)

55

With regards to defects within the optic tracts/radiations, is the macula spared?

Nope

56

Can optic tract/radiation pathologies cause incongruous defects?

Yes!

57

Which pathologies affect the occipital cortex?

Vascular disease (cerebrovascular accident)
Demyelination (multiple sclerosis)

58

Do pathologies affecting the occipital cortex result in macular sparing?

Yes!

59

Can occipital cortex pathologies cause incongruous defects?

No - tend to be congruous

60

A ring enhancing lesion on MRI tends to be characteristic of what?

Abscess (TB, parasites, chronic bacterial infection)

61

Over which age is vascular disease the most common aetiology (in general) for neuro-opthalmic disease?

>50

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