Neuro-Ophth

Front 1

Cogan's dictum for homonomous hemianopia

Back 1

asymmetric OKN indicates parietal lobe lesion, symmetric OKN indicates occipital lobe lesion

Front 2

CN most prone to injury in cavernous sinus

Back 2

CN 6

Front 3

lesion location in seesaw nystagmus

Back 3

suprasellar lesion

Front 4

ipsilateral Horner's syndrome and contralateral CN4 palsy

Back 4

midbrain lesion

Front 5

OKN strip moved to the left stimulates

Back 5

right frontal, left occipital

Front 6

horizontal gaze center: smooth pursuit

Back 6

- ipsilateral parieto-occipital lobe to superior colliculus to PPRF to horizontal gaze center (CN6 nucleus) to ipsilateral LR and contralateral MR via MLF (medial longitudinal fasciculus)

Front 7

vertical smooth pursuit

Back 7

interstitial nucleus of Cajal

Front 8

horizontal smooth pursuit

Back 8

ipislateral parieto-occipital lobe

Front 9

speed of smooth pursuit

Back 9

slow eye movements

Front 10

horizontal gaze center: saccades

Back 10

contralateral frontal eye fields (frontal lobe) to superior colliculus to pintine paramedian reticular formation (PPRF) to horizontal gaze center (CN6 nucleus) to ipislateral LR and cotnralateral MR via medial longitudinal fasciculus (MLF)

Front 11

Vergence system

Back 11

frontal and occipital lobes and midbrain

Front 12

horizontal gaze center: saccades

Back 12

contralateral frontal eye fields (frontal lobe) to superior colliculus to pontine paramedian reticular formation to horizontal gaze center (CN6 nucleus) to ipsilateral LR and contralateral MR via MLF

Front 13

One and a half syndrome

Back 13

- Fisher syndrome
- CN6 nucleus and ipsilateral MLF
- causes ipsilateral gaze palsy and INO
- only movement is abduction of contralateral eye with nystagmus

Front 14

downbeat nystagmus

Back 14

- lesions that affect pathway for downgaze
- cervicomedullary junction
- spinocerebellar degeneration
- lithium

Front 15

upbeat nystagmus

Back 15

- medullary lesion
- midline cerebellar (vermis) lesions
- MS

Front 16

ocular bobbing

Back 16

- rapid downward movements followed by slow return to primary position
- secondary to hemorrhage
- comatose patient

Front 17

ocular dipping

Back 17

- opposite of bobbing
- intermittent rapid upward movements followed by slow return to primary

Front 18

opsoclonus

Back 18

- saccadomania
- dancing hands and feet
- abnormality of pause cells that normally suppress burst cells of PPRF
- remote effect on cerebellum from metastatic neuroblastoma, occasionally with encephalitis

Front 19

CN6 palsy syndromes

Back 19

brain stem syndromes
- Millard-Gubler: CN6 and CN7 and contralateral hemiparesis
- Raymond's: CN6 and contralateral hemiparesis
- Foville's: CN6, CN5, CN7and sympathetics
- Moebius: CN7, extra digits, mental retardation

Front 20

Ramsay-Hunt syndrome

Back 20

HZV of outer ear and inner autidotry canal, 20% hearing loss and dizziness

Front 21

facial myokymia

Back 21

if multifocal and progressive consider MS

Front 22

eyelid myokymia

Back 22

benign lid fasciculation

Front 23

Eaton-Lambert syndrome

Back 23

paraneoplastic, impaired presynaptic release of ACh, antibodies against presynaptic votage-gated Ca-channels

Front 24

CHAMPS

Back 24

controlled high-risk Avonex MS prevention study: 3 year risk lower and fewer MRI lesions

Front 25

ONTT

Back 25

optic neuritis treatment trial
30% MS at 5 years regardless of treatment (16% with no, 51% with lesions)

Front 26

CN3 palsy syndromes (fascicle)

Back 26

Nothnagel's: CN3 and superior cerebellar peduncle (cerebellar ataxia)
Benedikt's syndrome: CN3 and red nucleus (contralateral hemitremor and decreased sensation)
Weber's syndrome: CN3 and pyrimidal tract with contralateral hemparesis

Front 27

diabetic CN3 palsy

Back 27

pain possible but no aberrant regeneration

Front 28

VER

Back 28

not useful for distinguishing optic neuropathy form retinal disorders

Front 29

lesions affecting the optic tract may be associated with

Back 29

- unilaterally decreased visual acuity
- ipsilateral APD
- contralateral APD
- homonymous hemianopia

Front 30

T1-weighted images

Back 30

renerated by short repetition times (TR) and short echo times (TE)

Front 31

life-expectancy in CRAO

Back 31

same

Front 32

Percentage of MS patients who will develop optic neuritis?

Back 32

55%

Front 33

Percentage of patients with severe MS and optic neuritis on autopsy?

Back 33

100%

Front 34

Percentage of pts with opitc nerve glioma who have neurofibromatosis

Back 34

12-38%

Front 35

location of alexia with agraphia

Back 35

domiant angular gyrus

Front 36

location of alexia without agraphia

Back 36

occipital lobe and corpus callosum

Front 37

location of cerebral dyschromatopsia

Back 37

unilateral or bilateral inferior occipitotemporal junction

Front 38

location of unformed hallucinations

Back 38

bialteral inferior occipitotemporal junction

Front 39

6th nerve palsy due to intracavernous lesion

Back 39

- may present as abduction palsy plus miosis
- in cavernous sinus, sympathetic branches of the paracarotid plesux joins the 6th nerve briefly

Front 40

first saccadic movement to be affected in progressive supranuclear palsy

Back 40

downward

Front 41

latency in generating a pursuit movement

Back 41

shorter than that for a saccade

Front 42

dorsal midbrain syndrome associated with

Back 42

- upward gaze paresis
- accommodative abnormalities
- light-near dissociation
- lid retraction
- NOT: paradoxic OKN

Front 43

Percentage of patients with Bell's palsy with complete spontaneous recovery

Back 43

75%

Front 44

cranial nerve most frequently involved in neurosarcoidosis

Back 44

1st: CN7, 2nd CN2

Front 45

pathway for accomodative miosis

Back 45

enters Edinger-Westphal nucleus anterior to the pathway for light-induced miosis

Front 46

most common etiology of doral midbrain syndrome in child under 10 years of age

Back 46

pineal gland tumor

Front 47

pupillary dilation only sign of CN3 palsy in which disorders

Back 47

- uncal herniation
- basilar meningitis

Front 48

most commonly motor nerve affected in MS

Back 48

CN6

Front 49

chronic sinopulmonary infections seen as part of what phacomatosis

Back 49

ataxia-teleangiectasia

Front 50

most frequently involved extraocular msucle in Graves ophthalmopathy

Back 50

- 1st inferior rectus
- 2nd medial rectus
- least frequently: lateral rectus

Front 51

percentage of patients with myasthenia gravis who develop Graves disease

Back 51

5%

Front 52

percentage of patients with myasthenia gravis who develop thymoma

Back 52

10%

Front 53

cues to presence of high-grade carotid stenosis

Back 53

- low-grade anterior segment inflammation
- cataract
- hypotony
- contralateral corneal arcus

Front 54

neurologic association with Coats disease

Back 54

- facioscapulohumeral dystrophy
- Turner's syndrome
- Senir-Loken syndrome
- epidermal nevus syndrome

Front 55

releave downbeat nystagmus in Arnold-Chiari

Back 55

- clonazepam
- basilar craniectomy

Front 56

Parinauds dorsal midbrain syndrome

Back 56

pinealoma

Front 57

differential for presumed posterior ischemic optic neuropathy

Back 57

- radiation optic neuropathy
- post-coronary artery bypass graft surgery
- giant cell arteritis

Front 58

meningioma arising in which location is most likey to lead to opitic disc edema

Back 58

optic nerve sheath (must be 1 cm or closer)

Front 59

skew deviation

Back 59

vertical misalignment of visual axes due to imbalance of prenuclear inputs
brain stem infarct, MS, high ICP, vertebral basilar insufficiency

Front 60

diabetic papillopathy

Back 60

- vision loss mild
- independent of degree of BS control

Front 61

sudden severe headache with accompanying acute visual loss is a well-recognized compolication of

Back 61

pituitary adenoma

Front 62

tropia pattern in bilateral 4th nerve palsy

Back 62

V pattern esotropia

Front 63

brainstem nuclei critical for generation of normal vertical eye movements

Back 63

- rostral interstitial nucleus of medial longitudinal fasciculus
- interstitial nucleus of Cajal

Front 64

bilateral INO

Back 64

more common in demyelinating disease (perfusion respects midline)

Front 65

brainstem lesion that involves both medial longitudinal fasciculi near their junctions with the third nerve nuclei may cause

Back 65

walleyed bilateral INO

Front 66

Variant of Guillain-Barre syndrome that only involves the brainstem and cranial nerves

Back 66

Fisher syndrome

Front 67

prevalence of giant cell arteritis in above 50 yos

Back 67

1 in 75.000
1% in above 90 yo

Front 68

prevalence of polymyalgia rheumatica over 50 yo

Back 68

1 in 200

Front 69

parasympathetic fibers destined for pupil reside in

Back 69

medial portion of CN3

Front 70

lesion of left occipital lobe

Back 70

may show monocular right temporal visual feild defect

Front 71

aberrant regeneration

Back 71

never seen after vascular lesion

Front 72

laterality of facial spasm

Back 72

- hemifacial spasm unilateral 90-95%
- blepharospasm always bilateral but may be asymmetric

Front 73

Parks-Bielschowsky 3-step test

Back 73

1. Which eye is hyperopic?
LH: paresis of OD elevators (RSR or RIO) or OS deressors (LIR or LSO)
2. Worse on right or left gaze?
If hyper, is wore in left gaze: OS muscles with greatest vertical action during abduction (SR and IR); OD muscles that have greatest vertical action during adduction (SO and IO)
SR and IR best in ABduction: if left hyper worse on left gaze: LIR
SO and IO best in ADduction: if left hyper worse on left gaze: RIO
if LH worse on right gaze: RSR or LSO
3. Worse on right or left tilt? If 1 of the intorters is cause then will worsen hyper on side of head tilt
If worse hyper on left head tilt, problem with left intorters (LSRR, LSO) or right extorters (RIR, RIO)

Front 74

ocular myasthenia gravis

Back 74

antibodies only found in less than 60%
less than 20% chance of systemic MG

Front 75

CN6 nucleus lesion and gaze palsy

Back 75

gaze palsy to same side (nucleus has interneurons destined for the contralateral medial rectus subnucleus via the MLF/medial longitudinal fasciculus)

Front 76

muscles innervated by crossed projections

Back 76

superior rectus (subnucleus), superior oblique

Front 77

superior orbital fissure

Back 77

CN3, 4, 5/1, 6

Front 78

Benedikt's syndrome

Back 78

CN3 palsy, contralateral decreased sensation, contralateral tremor

Front 79

optokinetic reflex drum rotating left and left VF defect

Back 79

acutely ipsilateral pursuit affected

Front 80

cocaine

Back 80

inhibits reuptake of norepinephrine; no dilation in Horners because no NE present (only works if all 3 neurons are intact)

Front 81

amphetamine

Back 81

cause release of NE (only works if 3rd neuron intact)

Front 82

parasympathetic fibers to lacrimal gland synapse in which ganglion

Back 82

sphenopalatine

Front 83

Bourneville's

Back 83

tuberous sclerosis

Front 84

Sturge-Weber

Back 84

encephalo-trigeminal angiomatosis

Front 85

von Hippel-Lindau

Back 85

angiomatosis retinae

Front 86

psammoma bodies

Back 86

ON meningioma

Front 88

von Recklinghausen

Back 88

neurofibromatosis

Front 89

Louis-Bar

Back 89

ataxia-telangiectasia