Neuro Eye

Front 1

T or F: APD doesn't cause anisocoria

T or F: Cataracts can cause an APD

Back 1

T

F

Front 2

Most common cause of a 20/20 APD is?

Back 2

asymmetric glaucoma

Front 3

What percent of the population has physiologic anisocoria?

T or F: the size difference is usually less than 1mm and the aniso can be slightly greater in the dark

Back 3

20%

T

Front 4

What diagnostic feature will congential Horner's have that acquired doesn't have?

Back 4

heterochromia of the iris

Front 5

What's the syndrome that can cause Horner's due to CVA?

What part of the pathway does it effect? (1,2,3)

Back 5

Wallenberg's synd.

1st order neurons

Front 6

Thyroid adenoma, Pancoasts tumor and phrenic nerve syndrome can all cause what?

Where in the pathway does this occur?

What's is pancoast's?

Back 6

Horner's

2nd order aka preganglionic neurons

carcinoma of the lung apex causing arm pain and having a hx of smoking

Front 7

If a person has Horner's caused by ICA dissection, what other symptoms will they have?

Back 7

acute onset pain and dysgeusia (altered taste)

Front 8

What is dilation lag, when is it most dramatic and what condition is it seen in?

Back 8

The miotic pupil is slower to dilate in the dark; 4-5 secs; Horner's

Front 9

Kearn's lower lid sign is seen in what condition?

Back 9

Horner's (it's an inverse ptosis of the lower lid)

Front 10

Horner's

1. Cocaine: what % used? Will it dilate Horner's? be specific
2. Apraclonidine: what % used? Does it dilate Horner's? be specific
3. What are contraindications of using Apraclonidine?

Back 10

1. 2-10%; no
2. .5-1%; yes all order horner's
3. cardiovascular problems, infants

Front 11

What drug do you use if you want to localize where a Horner's lesion is? (percentage as well)

What will happen?

Back 11

Hydroxyamphetamine 1%;

1st and 2nd order: will dilate
3rd order: poor dilation

Front 12

T or F: cocaine 2% is not reliable in children

Back 12

F hydroxyamphetamine 1%

Front 13

When you dx Horner's with eyedrops, what's the next step?

Back 13

1st and 2nd order: MRI brain/neck, chest x-ray/CT
3rd order: MRI head/neck, MRA if carotid dissection suspected (symptoms=TIA, Amarousis fugax)

Front 14

When do you think serious pathology in 3rd order Horner's lesion?

Back 14

pain or HA assoc. or other cranial nerves involved

Front 15

If you see bilateral tonic pupils in a male patient, what testing do you want to do?

Back 15

Syphilis testing (VDRL or syphilis screening, etc)

Front 16

The vast majority of argyll-robertson pupils are caused by ____.

What are other causes?

Back 16

diabetes

Neurosyphilis, sarcoid, MS, chronic alcoholism

Front 17

Describe the classical A-R pupils.

Is VA low or normal?

Unilateral or bilateral?

Back 17

Miotic, irregular pupils with poor light response and brisk near response. Poor dilation to dark and mydriatics.

Normal VA.

Usually bilateral.

Front 18

T or F: iritis will cause miotic pupils

Back 18

T

Front 19

Sectoral paralysis, stromal streaming and stromal spread all occur with what condition?

Back 19

tonic pupils (Adie's)

Front 20

Adie's pupil:

1. Usually unilateral or bilateral?
2. ____ rxn to light and ___ rxn to near
3. what population of people does it mostly affect?
4. what will be absent on the ipsilateral side?

Back 20

1. unilateral (4% conversion to bilateral...ask Hx)
2. minimal; slow (as this progresses, a LND condition will occur since more neurons are going to the iris sphincter from the ciliary ganglion)
3.young-middle aged women (70%)
4. deep tendon reflexes (this is indicative of dorsal root ganglia lesion)

Front 21

What pharmacological testing do you do for Adie's pupil?

When does this not work?

Back 21

Pilocarpine 0.125% (weak); this will constrict the pupil due to supersensitivity

acute phase

Front 22

What is the work-up once you have Dx Adie's pupil?

Back 22

Usually not indicated; if pt <1 y.o. refer to r/o Riler-day syndrome (nerves don't form properly...Ashkenazi jews)

Front 23

1% Pilocarpine will/won't constrict accidental mydriasis due to atropine in medical personnel.

1% Pilocarpine will/won't constrict a CN3 palsied pupil.

Back 23

won't (although depends on strength of drop and time of onset)

will

Front 24

T or F: an isolated pupillary finding is almost never the sole manifestation of a CN3 palsy

Back 24

T

Front 25

T or F: if you evaluate a patient for CN3 palsy and you dx an incomplete palsy with pupil sparing due to aneurysm, the pupil has a low chance of becoming involved

Back 25

F...if an aneurysm is the cause, is will be involved within 5 days in 90% of pts

Front 26

What's the most common cause of LND pupils?

How's the VA?

Back 26

optic neuropathy or severe retinopathy

usually poor

Front 27

Dorsal midbrain syndrome= ____ syndrome.

What are the causes in the elderly and in young/middle age?

Back 27

Parinaud's

midbrain infarct; pinealoma

Front 28

Parinaud's syndrome

1. deficient ___ gaze
2. ____ ____ pupils (2 things)
3. what happens on attempted upgaze?

Back 28

1. upgaze
2. mid-dilated LND
3. retraction convergence nystagmus

Front 29

What must you test if there is a poor resonse to light?

Back 29

vertical saccades (Parinaud's)

Front 30

Aberrant regeneration of a CN3 palsy is always due to what 3 things?

Back 30

Aneurysm, Trauma, Tumor

Front 31

Nothangel's, Benedikt's, Weber's and Claude's syndromes are all conditions associated with what?

What should you test in these?

Back 31

CN3 palsy (Fascicular)

Have patient lift their arm (to inspect paresis, tremor)

Front 32

A subarachnoid space CN3 is most likely due to aneurysm of what artery?

The junction of this artery with which other artery is the most common cause of isolated CN3 palsy?

Back 32

Posterior communicating artery

basilar a

(in combo with other palsies, it would be where the PCoA meets the ICA)

Front 33

Whenever the cavernous sinus is implicated as the cause of a cranial nerve palsy, what else should you look for?

Back 33

OTHER cranial n involvement! as well as Horner's since 3,4,5,6 and sympathetic pass thru here

Front 34

If you have an orbital CN3 on your hands, what signs let you know that it is orbital?

Back 34

VA AFFECTED, APD (optic n. involvement)

Front 35

If you have a nuclear CN3 palsy, which muscle will be affected in the contralateral eye?

Back 35

SR

Front 36

T or F: pain is common in a microvascular CN3 palsy

Back 36

T...CN5 fibers may join CN3

Front 37

If the pupil is involved in a CN3 palsy, what imaging study is the best to order?

If this occured in an elderly pt, what else do you want to order?

Back 37

CTA

ESR (sed rate)

Front 38

What are the most common causes of CN3 palsy in an adult patient besides undetermined?

What about a child?

Back 38

vascular and aneurysm

congenital, trauma

Front 39

What exam finding will a lonstanding CN4 palsy have that a new onset won't?

Back 39

large vertical fusional amplitude

Front 40

CN4 palsy:

1. what's the w/u for non-vasculopathic age?
2. vasculopathic age?

Back 40

1. r/o MG/MS/mass...do Tensilon...if normal or hx of trauma-> MRI

2. DM/HTN testing (imaging not needed if you suspect this)

Front 41

When you have a 6th nerve palsy, what other cranial nerve should you test? why?

Back 41

7th; it loops over CN6

Front 42

A syndrome affecting CN ___ around the petrous portion of the skull is called what?

Back 42

6; Gradenigo's: ipsilat. CN6 palsy with ear pain and trigeminal pain (facial pain and paralysis)

Front 43

CN6 palsy in adults: undetermined, other, _____, trauma, ____, aneursym

in children: ___, ___ misc, inflamm, congenital

Back 43

neoplasm; vascular

trauma, neoplasm (pontine glioma)

Front 44

What nerve palsy is commonly due to the post viral phase in children?

W/U?

Back 44

CN6

watch 2 wks then 4 wks...if doesn't improve or other neuro symptoms: MRI

Front 45

CN6 palsy: image all __, ___, h/o ___

Back 45

pain, neuro signs, history of cancer

Front 46

Only call CN6 palsy ______ until r/o ______ or______.

Back 46

abduction defecit; restriction; MG

Front 47

Tx for myasthenia gravis:

1. Mestinon:
2. Prostigmin:
(what category are these two?)
3. Corticosteroids:
4. _____: Asathioprine, cyclosporine, mycophenolate, cyclophosphamide
5. ____: short term for impending crisis or sx gone wrong

Back 47

1. 60 mg BID-TID up to 120 mg QID
(more systemic aspect)
2. 15 mg tab up to QID
(anticholinesterases)
3. 60-80 loading dose and taper to 10-20 mgs every other day
4.immunosuppressives
5. plasmapharesis

Front 48

MGTX study: taking AChR-Ab positive non-thyomatous pts and doing what?

Back 48

Performing and not performing thymectomy (both using Prednisone)