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Flashcards in Neurology eye (delta) Deck (68):
1

Inferior obqlie action

Extorsion
Elevation
Abduction

2

Inferior rectus action

Depression

3

Medial rectus action

Adduction

4

Superior rectus action

Elevation

5

LPS action

Retraction of eyelid

6

Superior oblique action

Incyclotorsion
Depression
Abduction

7

Lateral rectus action

Abduction

8

CNs that originate from midbrain

Oculomotor
Trochelar

9

CNs that originate from pons

Trigeminal
Abducens

10

CNs at cerbellopontine angle

Facial nerve
Vestibulocochlear

11

CNs that originate at medulla

Glossopharyngeal
Vagus
Spinal accessory
Hypoglossal

12

Accomodation

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

13

Signs of optic nerve dysfunction

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

14

Systemic clinical features of MS

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

15

Opthalmic features of MS?

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

16

What can be seen on ix for MS?

Demyelinated plaques on MRI
Oligoclonal bands in CSF on LP

17

Tx for optic neuritis

IV methylprednisolone followed by PO prednisolone

18

What is neuromyelitis optica?

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

19

What can be seen on investigation of neuromyelitis optica?

IgG antibody against AQP4

20

What is AION?

Damage to optic nerve as a result of ischaemia
Can be non-arteritic or caused by giant cell arteritis

21

Presentation of non-arteritic AION

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

22

Presentation of GCA

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

23

What is papilloedema?

Optic disc swelling due to elevated ICP

24

Clinical features of papilloedema

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

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