633 - 5 Differential Diagnosis Of Optic Neuropathies

Front 1

out of all of the DDx for optic neuropathy what is the most common cause

Back 1

glaucoma

Front 2

what are the three most common causes of optic neuropathy

Back 2

glaucoma, optic neuritis, and anterior ischemic optic neuropathy

Front 3

what are the clinical features of optic neuropathy

Back 3

decreased VA, decreased color vision, VF defect, RAPD (in unilateral cases), optic disc edema/atrophy (except in retrobulbar)

Front 4

describe the vision loss in typical optic neuritis

Back 4

acute unilateral loss of VA or VF (1-10 days)

Front 5

typical optic neuritis is more common in males or females

Back 5

females

Front 6

with typical optic neuritis is the ONH more commonly swollen or normal looking

Back 6

65% normal looking. in other words it is retrobulbar

Front 7

what is the most common VF pattern loss with a person that has typical optic neuritis

Back 7

central scotoma

Front 8

what systemic abnormalities should you look for in a pt that has optic neuritis

Back 8

does it worsen with heat, loss of coordination, fatigue, pins and needles in extremities, urinary incontinance especially in women

Front 9

what is the presenting sign in 35% fo cases of MS

Back 9

optic neuritis

Front 10

the optic neuritis treatment trial (ONTT) was used to test the efficacy of what kind of drugs on ON

Back 10

corticosteroids

Front 11

what type of ocular pain will a pt with ON feel

Back 11

periocular pain with eye movement

Front 12

what was the result of the oral prednisilone group in the ONTT

Back 12

made them more suseptible to ON attacks

Front 13

what was the out come for the IV group in the ONTT

Back 13

fast recovery fo all visual measures but no long term benefit 6-12 months after Tx they were equal to other groups

Front 14

if a person with ON is not in a need for fast visual recovery what is the best way to treat them

Back 14

nothing should be done

Front 15

do most pts with ON recover to 20/20 or not

Back 15

only 2% will not get better than 20/40 but pt's often report that their vision is just not right may be b/c their contrast sensitivity tends to remain reduced

Front 16

how long does it take for a typical pt to start recovering from ON

Back 16

usually starts with in a month

Front 17

a pt with ON could have pallor due to what

Back 17

this is from previous episodes

Front 18

is anterior ischemic optic neuropathy usually painful or painless

Back 18

90% painless

Front 19

what age is anterior ischemic optic neuropathy usually found

Back 19

>50

Front 20

could anterior ischemic optic neuropathy cause an RAPD

Back 20

yes

Front 21

what type of visual field loss is usually found in anterior ischemic optic neuropathy pt's

Back 21

usually altitudinal (whole bottom half maybe top?) but can have other patterns

Front 22

a pt with AION will not have premonitory symptoms but may have what as an early sign

Back 22

disc edema

Front 23

what is the typical recovery like with AION

Back 23

typically limited visual recovery and may have continuingloss

Front 24

is there a ton of associated disorders with AION or very few

Back 24

tons look them up slide 19

Front 25

when is aterior ischemic optic neuropathy considered arteritic

Back 25

when there is inflammation involved

Front 26

what is the most common cause of arteritic anterior ischemic optic neuropathy

Back 26

giant cell arteritis.

Front 27

if AAION is not treated quickly most people will have bilateral vision loss in what amount of time

Back 27

70% will have bilateral loss in one week

Front 28

what kind of symptoms would you ask a pt about if you suspected or were trying to rule out GCA

Back 28

HA's, scalp tenderness, weight loss, jaw caudication, fever, fatigue and or malaise. you should also check for decreased temporal artery pulse

Front 29

what lab tests could you run on a pt that is suspected of having GCA

Back 29

sed rate and/or c reactive protein like the westergren sed rate or the c reactive protien.

Front 30

how many symptoms must a pt have to diagnose them with GCA

Back 30

3 or more. things like over 50, new local HA, temp tenderness, abnormal biopsy, or sed rate/c protein is high

Front 31

what drug could you start a pt on if you suspect GCA even before a biopsy

Back 31

steroids-
eye involvment methylprednisolone 250 mg IV bid x5 days followed by oral
or 60 to 100 mg prednisone PO qd

Front 32

what has a lower risk of developing into bilateral involvement AAION or NAION

Back 32

NAION

Front 33

a pt with peripapillary and macular exudates as well as swelling of the ONH. what is the condition and would you likely see vitreous cells

Back 33

optic disc edema with macular star and yes you could see vitreous cells

Front 34

most cases of ODEMS are idiopathic but could possibly be due to what type of infection

Back 34

viral

Front 35

non typical cases of ODEMS are generally associated with what type of problems

Back 35

cardivascular like HTN, DM, CRVO or BRVO

Front 36

what kind of recovery is seen with pts that have ODEMS

Back 36

disc edema resolves spontaneously in 2-3 months and the macular star may persist up to one year. VA is generally good after resolution

Front 37

you have pt that has disc edema but you do not believe they are at risk for MS. what should you look for with in the following two weeks

Back 37

watch for a macular star to develope

Front 38

what is the Tx for a pt with ODEMS

Back 38

there is no specific treatment unless you know what infectious agent is causing it

Front 39

a pt with painless progressive gradual loss of VA, VF and color vision, you notice a RAPD possibly ONH edema and atrophy what could be the problem................................. one more clue they may have proptosis

Back 39

compressive optic neuropathy

Front 40

Infiltrative or inflammatory ON is it unilateral or bilateral

Back 40

often bilateral

Front 41

what are some systemic conditions that may be present in a person that has infiltrative/inflammatory ON

Back 41

Behcets, IBD, reiters, sarcoid, SLE, etc

Front 42

when you think of typical ON what dz do you think of

Back 42

MS

Front 43

why would you perform a lumbar puncture on a person with ON

Back 43

to rule out papilladema

Front 44

would you expect more or less swelling with traumatic optic neuropathy

Back 44

less swelling than other causes of ON

Front 45

what type of imaging should you order for a pt that has traumatic ON

Back 45

CT to rule out other damage

Front 46

most types of ON are asymetric name one that is symmetric

Back 46

toxic or nutritional

Front 47

what type of visual fields would be normal for a person with toxic or nutritional optic neuropathy

Back 47

bilateral central or cecocentral scotomas

Front 48

most common causes of toxic or nutritional optic neuropathy

Back 48

ehambutol and isoniazid (Tb)
ethanol, tabacco, pernicious anemia, and dietary deficiency

Front 49

how would you test for a heavy metal such as lead

Back 49

urine evaluation

Front 50

what is the most common hereditary optic neuropathy

Back 50

leber's hereditary optic neuropathy

Front 51

what type of pt would you suspect lebers hereditary optic neuropathy in

Back 51

young male age 18 to 30 with unexplained asymmetric or bilateral vision loss or optic neuropathy

Front 52

a pt with pseudoedema of the ONH with no leakage, and telangiectatic microangiopathy what do you suspect

Back 52

lebers hereditary optic neuropathy. looks like classic edema but it is not

Front 53

how do you treat Leber's hereditary optic neuropathy

Back 53

there is no treatment to stop the dz but the periphery is spared so you can help the pt with low vision aids, mobility training and genetic counseling

Front 54

what systemic problem should you talk to the pt about if they have LHON

Back 54

cardiac problems

Front 55

a pt with LHON will have non glaucomatous cupping and ONH pallor on what side of the ONH

Back 55

temporal

Front 56

with LHON does the fundus signs show up early or late? (attenuated arterioles, nfl loss in papillomacular bundle, and temporal ONH pallor with non glaucomatous cupping

Back 56

late fundus appearance

Front 57

what should you check on every pt before working your way through the decision tree

Back 57

always check Bp and blood glucose

Front 58

what is the most common cause of papilledema

Back 58

pseudotumor cerebri but a mass lesion always needs to be ruled out

Front 59

a pt with possible papilledema and you suspect a neuro vascular problem then what type of imaging should you order

Back 59

ct - this would be like after a head injury or acute vascular process

Front 60

if there are no abnormalities on imaging of a possible papilledema pt what do you do next

Back 60

order a lumbar puncture

Front 61

how do you diagnose idiopathic intracranial hypertension

Back 61

it is a diagnosis of exclusion

Front 62

what type of a person is idiopathic intracranial hypertension more common in

Back 62

obese women

Front 63

what could you give a pt that has ideopathic intracranial hpertension to help reduce the intracranial pressure

Back 63

diamox 500mg bid if it is a long wait to see a neurologist or if it is acute and there is severe vision loss you could use corticosteroids

Front 64

what vitamin could an overdose cause idiopathic intracranial hypertension

Back 64

vit A