Ocular Disease Iii - Cavernous Sinus

Front 1

Anterior boundary of cavernous sinus?

Back 1

sup orbital fissure

Front 2

Posterior boundary of cavernous sinus?

Back 2

petrous apex of temporal bone

Front 3

Medial boundary of cavernous sinus?

Back 3

sphenoid sinus

Front 4

Lateral boundary of cavernous sinus?

Back 4

dural tissue

Front 5

Vascular supply of cavernous sinus (venous and arterial)?

Back 5

Venous = sup & inf ophthalmic v.
Arterial = smaller branches of int carotid

Front 6

Drainage of cavernous sinus?

Back 6

sup & inf petrosal sinuses

Front 7

Connection of two cavernous sinuses?

Back 7

intercavernous sinus

Front 8

CNs in cavernous sinus?

Back 8

CN III, IV, V1, VI

Front 9

Oculosympathetic fibers in cavernous sinus?

Back 9

Pupil dilator, sup lid elevation, inf lid depression

Just think "wide cavern" - all of these involve widening of the eye fissure or pupil

Front 10

T/F - Pain is involved with cavernous sinus syndrome

Back 10

True - orbital or hemicranial

Front 11

T/F - Proptosis is possible with cavernous sinus syndrome.

Back 11

True

Front 12

T/F - Chemosis of the conj is possible w/ cavernous sinus syndrome.

Back 12

True

Front 13

Review causes of cavernous sinus syndrome

Back 13

(Just a reminder)

Front 14

What CN is most likely involved in pituitary adenomas within the cavernous sinus?

Back 14

CN III - due to its position, close to pituitary
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Front 15

Laterality of pituitary adenomas - unilat, bilat, both?

Back 15

Unilat or asymmetrical bilat

Front 16

Pituitary adenomas are (fast/slow) growing, pituitary apoplexy are (fast/slow) growing

Back 16

slow, fast

Front 17

Pituitary apoplexies are caused by...

Back 17

secondary to infarct or hemorrhage

Front 18

Intercavernous aneurysms are due to an aneurysm of what BV?

Back 18

internal carotid

Front 19

T/F - Intercavernous aneurysms are slowly progressive.

Back 19

True

Front 20

T/F - Intercavernous aneurysms most likely involve CN III.

Back 20

False - CN VI, due to location (But III, IV, and V1 can also be involved)
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Note location of CN VI adjacent to carotid

Front 21

T/F - Pts with intercavernous aneurysms causing CN III palsy will not have a dilated pupil.

Back 21

True - pupil will be small and non-responsive to light and near

Front 22

Describe how the pupil behaves in intercavernous aneurysms causing CN III palsy.

Back 22

Sympathetic and parasymp fibers both involved, thus pupil is small and non-responsive to light or near

Front 23

Rupture of intercavernous aneurysms result in...

Back 23

carotid-cavernous fistula

Front 24

Horner's with EOM palsy should make you think that the cause is...

Back 24

in the cavernous sinus

Front 25

Meningiomas are (slow/fast) growing and (malignant/benign)?

Back 25

slow, benign

Front 26

Most common benign intracranial tumor?

Back 26

meningiomas

Front 27

T/F - Meningiomas more commen in men.

Back 27

False - women

Front 28

You see engorged episcleral veins, increased IOP, chemosis, and lid edema; the pt has a Hx of a punch to the head. Dx?

Back 28

Classic carotid-cavernous fistula; high pressure ICA blood travels up superior ophthalmic vein

Front 29

What vessel does blood backflow thru in a classic carotid-cavernous fistula, causing chemosis, lid edema, engorged episcleral veins, etc?

Back 29

superior ophthalmic vein

Front 30

Dural-cavernous fistula happens by...

Back 30

dural branches of ICA or external carotid into CS; tear in meningiohypophyseal artery most common

Front 31

T/F - Dural-cavernous fistula typically middle aged elderly males.

Back 31

False - females

Front 32

Dural-cavernous fistula is (low/high) pressure, (low/high) flow.

Back 32

low, low

Front 33

What incr risk of Dural-cavernous fistula?

Back 33

Arteriosclerosis, HTN, collagen vascular dz, pre-existing aneurysm/cong weakness

Front 34

In your 60yo female pt, you see engorged episcleral veins and very high IOP. Since you suspect glaucoma, you check the angles and see blood in Schlemm's. You definitely need to R/O...

Back 34

Dural-cavernous fistula

Front 35

Dural-cavernous fistula has __ to __% spontaneous resolution within ___mos.

Back 35

50, 60, 3

Front 36

Mx of Dural-cavernous fistula?

Back 36

neuro consult

Front 37

Describe Tolosa-Hunt syndrome signs/Sx. What structures can be involved?

Back 37

Painful & recurrent lasting days-weeks; severe periorbital or hemicranial pain.

Idiopathic, granulomatous inflammation of CS; Can involve CNs II-VII and oculosympathetics

Front 38

Mx of Tolosa-Hunt syndrome?

Back 38

Dx of exclusion - neuro consult, CT/MRI of orbit, steroids

Front 39

Cause of Tolosa-Hunt syndrome?

Back 39

Idiopathic