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36 Cards in this Set
- Front
- Back
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Congenital Anomalous Disc Elevation
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absence of edema, hemorrhage and presence of Simul. Venous Pulsation (SVP)
Think: optic disc drusen and hyperopia |
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Papilledema
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Presence of bilateral edema, hemorrhage and absence of SVP
disc swelling caused by high ICP headache worse in morning nausea/vomiting, horizontal diplopia (CN VI palsy) Think: hypertension (must check BP) and brain tumor |
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Papillitis/Anterior Optic Neuritis
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unilateral edema, hemorrhage
Think: inflammatory disorders, MS |
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Ischemic Optic Neuropathy
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Pallor, swelling, hemorrhage
altitudinal visual field loss |
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Optic Atrophy
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Think: previous optic neuritis or ischemic optic neuropathy, long-standing papilledema, optic nerve compression by a mass lesion, and glaucoma
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Pale Optic Disc
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congenital, secondary to raised ICP, vascular retinal disease, optic neuritis, optic nerve compression, trauma, glaucoma
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Where would you expect lesions for monocular visual field defects?
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anterior to the optic chiasm
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hallmark of chiasmal lesions
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Bitemporal defects
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what causes Binocular Homonymous Hemianopia?
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lesions in the contralateral postchiasmal region
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what do optic tract lesions reflect?
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Binocular Quadrantanopia (loss in 1/4 of visual field)
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what causes a central scotoma
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optic neuritis
unilateral - compressive lesion of ON (ipsilateral), macular lesion bilateral - toxic optic neuropathy or nutritional deficiency |
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where would a lesion cause total blindness of the right eye?
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complete lesion of right optic nerve
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where would a lesion cause bitemporal hemianopia?
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complete lesion of optic chiasm (pituitary tumor)
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where would a lesion cause right nasal hemianopia?
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perichiasmal lesion (infarct)
lesion of the optic tract anterior to the chiasm |
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where would a lesion cause a right homonymous hemianopia
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complete contralateral left optic tract lesion; brain injuries such as stroke or trauma and or benign or malignant tumors
OR complete lesion of the left optic radiation; intracranial lesion but mostly intracranial hemorrage trauma |
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where would a lesion cause a Right Homonymous Superior Quadrantopia
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partial involvement of the optic radiation in the left temporal lobe (Meyer's loop),
visual hallucinations and seizures |
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where would a lesion cause a Right Homonymous Inferior Quadrantopia
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partial involvement of the optic radiation in the left parietal lobe,
visual perception difficulty, agnosia (inability to recognize objects, persons, sounds, shapes or smells) usually associated with brain injury or neurological illness |
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where would cause a Right Homonymous Hemianopia (with macular sparing)
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infarct from a posterior cerebral artery occlusion causing ischemia of the calcarine cortex of the occipital lobe
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1st order pupil
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Retina to Pretectal Nucleus in B/S
(at level of Superior colliculus) |
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2nd order pupil
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Pretectal nucleus to E/W nucleus
(bilateral innervation!) |
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3rd order pupil
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E/W nucleus to Ciliary Ganglion
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4th order pupil
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Ciliary Ganglion to Sphincter pupillae (via short ciliary nerves)
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oculomotor nerve palsy (CN III)
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double vision, ptosis, exotropia (eye turned down and out), pupil fixed and dilated, +/- pain
Think: (Adult) PCA – Aneurysm, Brain Tumor, Trauma, Hypertension, Diabetes Think: (Children) Congenital Trauma, Tumor or Ophthalmic Migraine assoc. with headache Pupil Involvement - compressive lesion (aneurysm or tumor) Pupil Sparing – Diabetes, Hypertension |
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Trochlear Nerve Palsy (CN IV)
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Isolated – Congenital (most common), may occur in elderly due to vertical muscle weakness.
Acquired – trauma; Acute vertical diplopia with head position (chin down, face turned to opposite side and head tilt to opposite shoulder) Think: 40% Trauma, 30% Ischemia, 20% Misc., 10% Aneurysm |
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Trigeminal Nerve Palsy (CN V)
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CN V - sensory to the face and eye and motor to muscles of mastication
Disorders: Trigeminal neuralgia (tic-douloureux) due to compression lesion of CN V @ root either by entrapment, aneurysm or tumor encroachment |
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Abducens Nerve Palsy (CN VI)
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eye is turned in; caused by increased Intracranial Pressure
Think: Orbital Pseudo Tumor, Cellulitis, Trauma, vasculopathic secondary to Diabetes Children – Post viral assoc. w/ otitis media, pontine glioma, trauma Adults – Vascularpathic, nasopharyngeal carcinoma, cavernous sinus meningioma |
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Facial Nerve Palsy (CN VII)
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Bell’s Palsy – acute unilateral idiopathic facial weakness progressing to paralysis over months
caused by trauma to temporal bone, infection (otitis), acoustic neuroma (tumor), benign essential blepharospasm (hemifacial spasm) |
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innervation of iris sphincter
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parasympathetic from Edinger-Westphal nucleus
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innervation to dilate iris
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sympathetic from Cilio-Spinal Center of Budge C8-T1
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1st order sympathetic pathway
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Posterior Hypothalamus to Ciliospinal center of Budge (C8-T2)
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2nd order sympathetic pathway
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Ciliospinal center of Budge to Superior Cervical Ganaglion
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3rd order sympathetic pathway
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Superior Cervical Ganglion to dilator pupillae muscle (Close to the Internal Carotid A. and joins CN V)
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Afferent Pupillary Defect (+APD) or Marcus Gunn pupil
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swinging flashlight test
light causes abnormal eye to dilate |
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Horner's syndrome
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Oculo-Sympathetic paresis
Ptosis Miosis Ipsilateral anhidrosis enophthalmos |
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Internuclear Ophthalmoplegia
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Defective adduction of the ipsilateral eye; NORMAL CONVERGENCE
Causes: Young patients - Bilateral, Demyelination Older patients - Unilateral Vascular, tumors |
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Myasthenia Gravis
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Fatigability
Double vision Lid twitch Ptosis Normal reflexes & sensation |
