Neurooptho

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kidbraindoc
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140016
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Neurooptho
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2012-04-23 20:47:59
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Neuro optho board review
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  1. This muscle changes the shape of the lens allowing accomodation
    Ciliary
  2. this is the center of the macula and is the region with the highest visual acuity.
    fovea
  3. The three cell layers of the retina:
    • - outer nuclear layer containing photoreceptors
    • - bipolar cell layer
    • - ganglion cell layer
  4. The difference between rods and cones.
    • Rods: more numerous and useful for night vision. found at the periphery
    • Cones: detect color. concentrated at the fovea
  5. This produces the blind spot
    Optic disc
  6. photoreceptors synapse on:
    bipolar cells
  7. bipolar cells synapse on
    ganglion cells
  8. axons of ganglion cells form
    optic nerve
  9. Most common pituitary tumor
    ademona
  10. binasal hemianopia occurs because:
    bilateral lateral compression of the optic chiasm. can result from calcified internal carotid arteries.
  11. corneal reflex components
    • afferent: opthalmic division of the trigeminal nerve
    • efferent: facial nerve
  12. inferior rectus:
    depresses and extorts
  13. inferior oblique
    elevates and extorts

    "inferiors extort money."
  14. optic nerve extis the skull through:
    optic canal
  15. oculomotor nerve exits the skull through:
    superior orbital fissure
  16. trochlear nerve exits the skull through:
    superior orbital fissure
  17. abducens nerve exits the skull through the:
    superior orbital fissure
  18. input to the visual pathway from the optic nerve:
    optic nerve-->optic chiasm-->optic tract-->lateral geniculate nucleus-->optic radiations--> visual cortex
  19. Pupillary light reflex pathway:
    optic nerve-->optic chiasm-->optic tract-->pretectal nuclei-->Edinger-Westphal nuclei-->ciliary ganglion-->short ciliary nerves
  20. complete oculomotor palsy:
    eye is down and out, ptosis and dilated nonreactive pupil.
  21. causes of CN 3 palsy:
    • - compression
    • - Posterior communicating artery aneurysm
    • - aneurysm at the junction of the posterior cerebral and superior cerebellar arteries as CN3 passes between these
    • - transtentorial herniation
  22. what could cause CN3 palsy with sparing of the pupil?
    Diabetes as it tends to affect the central fibers and not the pupilloconstrictor fibers
  23. This can also cause CN3 palsy with sparing of the pupil:
    myasthenia gravis
  24. superior division of CN3 innervates:
    superior rectus and levator
  25. inferior division of CN3 innervates the:
    inferior oblique, inferior rectus, medial rectus and pupillary sphincter
  26. This is the longest and most slender cranial nerve.
    Trochlear
  27. trochlear nerve palsy
    double vision worse when looking down and away from the lesion; head tilt to compensate; involved eye is elevated in primary gaze.
  28. one major cause of CN VI palsy
    increased ICP
  29. Diplopia in pts with CN VI palsy is worse when:
    the look laterally toward the side of the lesion.
  30. Orbital apex lesion:
    Optic nerve involvement, may have a bulging eye, also involves CN 3, 4, 6 V1
  31. Superior orbital fissure lesion involves these CN:
    3,4,6, V1
  32. Tolosa-Hunt is a cause of this:
    • cavernous sinus syndrome, involves CN 3,4,6, V1, V2.
    • It is a granulomatous inflammation in the cavernous sinus that results in painful opthalmoplegia. treat with prednisone.
  33. Edinger Westphal Nucleus innervates:
    pupillary sphincters and ciliary bodies.
  34. the long ciliary nerve carries sympathetic fibers to the:
    dilator of the pupil
  35. the short ciliary nerve carries parasympathetic fibers to the
    pupil constrictor and ciliary muscles.
  36. the medial longitudinal fasciculus travels from:
    the abducens nucleus to the contralateral oculomotor nucleus
  37. left abducens nucleus lesion causes:
    left gaze palsy due to the inability of the left eye to abduct and the right eye to adduct.
  38. internuclear opthalmoplegia:
    • caused by a lesion in the MLF which intterupts the connection between the abducens and contralateral oculomotor nucleus. causes difficulty addcuting the ipsilateral eye.
    • this can be seen in MS.
  39. INO vs CN3 palsy:
    INO; eye can adduct during convergence. CN3 palsy it cannot adduct during convergence.
  40. Brodmanns area for:

    Frontal eye fields:

    Primary Visual Cortex


    Visual association cortex:
    8

    17

    39,19,18
  41. upper bank of the calcarine cortex is called:
    the cuneus
  42. lower bank of the calcarine cortex is called:
    the lingual gyrus
  43. info from the right lower visual field is projected to:
    the left cuneus (upper bank)
  44. information from the right upper visual field is projected to:
    the left lingual gyrus (lower bank).
  45. patients with cortical blindness:
    have no blink to threat, no optokinetic responses but do have pupillary resonses to light.
  46. fast conjugate eye movements used to bring a target into view. there is some voluntary control. the frontal lobe generates these through connections with the PPRF.
    saccades
  47. this allows one to view a moving object. it is not under voluntary control. the parieto-occipital cortex generates ipsilateral of these.
    smooth pursuit movements.
  48. this is important in upgaze:
    posterior commisure
  49. this is important in downgaze:
    rostral interstitial nucleus of the MLF.
  50. causes painless vision loss of sudden onset:
    anterior ischemic optic neuropathy.
  51. this is the most common cause of persistent monocular vision loss in patients over 50 years old:
    AION, may occurin in giant cell arteritis.
  52. Horners syndrome:
    miosis, anhydrosis, ptosis
  53. Horners syndrome pupil:

    react to light??

    dilate with 10% cocaine?
    yes

    no
  54. amaurosis fugax:
    • temporary loss of vision.
    • due to emboli causing temporary occulsion of the retinal artery. often described as a shade coming down.
  55. Antons syndrome
    denial of cortical blindness. cause would be bilateral PCA infarcts resulting in bilateral occipital lobe damage.
  56. argyll-robinson pupil
    irregular, small pupil that reacts poorly to light but reacts to accomodation. associated with CNS syphillis.
  57. balint's syndrome triad:
    simultanagnosia; optic ataxia; ocular apraxia

    due to bilateral parietal-occipital damage.
  58. foster kennedy syndrome triad:
    ipsilateral anosmia; ipsilateral optic atrophy; contralateral papilledema.
  59. foster kennedy syndrome is associated with:
    a mass, like a meningioma, involving the olfactory groove or sphenoid ridge. the mass compresses one optic nerve, causing optic atrophy and increases ICP resulting in papilledema in the contralateral eye.
  60. What is the cause of Parinaud's syndrome?
    lesion in the dorsal midbrain affecting the superior colliculi and pretectum.
  61. What are the findings in Parinaud's syndrome?
    • 1) paralysis of upgaze and accommodation
    • 2) light-near dissociation
    • 3) eyelid retraction (Collier sign)
    • 4) convergence-retraction nystagmus on attempted upgaze.
  62. Riddoch phenomenon:
    a person can see moving fingers but not still fingers.
  63. What are the characteristics of spasmus nutans?
    • 1) titubation/nodding of the head
    • 2) nystagmus
    • 3) torticollis
  64. uhthoff's phenomenon:
    decreased visual acuity assocaited with increased temperature. it is seen in optic nerve disease.
  65. What is von Graefe sign and when can it be seen?
    • - when during downward gaze there is a lag of the upper lid
    • - can be seen in thyrotoxicosis.
  66. Weber's syndrome:
    • ipsilateral CN3 palsy and contralateral weakness.
    • due to a lesion in the ventral midbrain involving CN3 and the cerebral peduncle.
  67. This syndrome is characterized by the following triad:
    - agenesis of the corpus callosum
    - infantile spasms
    - chorioretinal lacunae (can also see optic nerve coloboma)
    Aicardi syndrome
  68. What are the genetics of Aicardi syndrome?
    x-linked dominant
  69. This is a type of recurrent vasculitis and can be associated with recurrent meningoencephalitis:
    Bechet disease
  70. What is the classic triad of Bechet disease?
    • - oral ulcers
    • - genital ulcers
    • - uveitis
  71. What is chronic progressive external opthalmoplegia?
    • - mitochondrial disease that begins after age 20.
    • - characterized by progressive bilateral ptosis and loss of eye movements.
  72. Homocystinuria is associated with this:
    downward lens subluxation
  73. What is Kearns-Sayre syndrome?
    • - mitochondrial disorder
    • - can have progressive external opthalmoplegia
    • - pigmentary retinopathy
    • - elevated CSF protein
    • - cerebellar syndrome
    • - endocrine abnormalities
    • - heart block
    • - mitochondrial myopathy
  74. What is Leber's Hereditary Optic Neuropathy?
    bilateral optic neuropathy due to a mitochondrial DNA point mutation.
  75. How does LHON present?
    as a painless loss of central vison usually beginning in adolesence or early adulthood.
  76. What causes locked in syndrome?
    bilateral ventral pontine lesions.
  77. What are the two things patients can do with locked in syndrome?
    blink and move their eyes vertically
  78. What is oculopharyngeal muscular dystrophy?
    • ptosis and impairment of EOM without diplopia.
    • starts in the 5th decade of life
    • can also have swallowing difficulty
  79. what causes oculopharyngeal muscular dystrophy?
    GCG repeat expansion in the gene encoding PABP2 on chromosome 14
  80. what does the pathology in oculopharyngeal MD show?
    rimmed vacuoles
  81. What is NARP?
    Neuopathy, Ataxia, retinitis pigmentosa
  82. What is the most common presentation of NARP?
    night blindness
  83. What causes NARP?
    mitochondrial disease. due to an ATPase point mutation
  84. What diseases cause a cherry red spot?
    • - Farbers lipogranulomatosis
    • - GM1 gangliosidosis
    • - Sandhoff disease
    • - Sialidosis
    • - Tay Sachs
    • - Neimann Pick Disease Type A
  85. What is opsoclonus myoclonus associated with?
    • - childhood neuroblastoma
    • - adults with anti-Ri AB which is associated with breast, gynecologic and lung cancers.
  86. What is Susac's syndrome?
    microangiopathy involving the brain, retina and cochlea that usually presents in young women.
  87. What is the triad of Susac's syndrome?
    • 1) branch retinal artery occlusions (BRAO)
    • 2) encephalopathy
    • 3) sensorineural hearing loss
  88. What are the typical brain MRI findings in Susac syndrome?
    multiple areas of high T2 signal, may resemble MS. involve the gray and white matter. the corpus callosum is often involved.
  89. What is the triad that characterizes Wernicke Encephalopathy?
    • 1) oculomotor palsy
    • 2) ataxia of gait
    • 3) confusion
  90. What is the cause of whipple's disease?
    gram positive bacillus (Tropheryma whippelii) which is PAS +
  91. what is the classic triad of Whipple disease?
    • 1) dementia
    • 2) supranucelar gaze palsy
    • 3) myoclonus
  92. What is Wolfram Syndrome?
    a constellation of diabetes insipidus, diabetes mellitus, optic atrophy and deafness (DIDMOAD)
  93. What can cocaine cause in terms of eye movements?
    opsoclonus
  94. What eye findings to ethylene glycol cause?
    non reactive pupils and loss of corneal reflexes
  95. what eye findings can ethambutol cause?
    optic neuropathy
  96. what eye findings can vigabatrin cause?
    bilateral concensual visual field defects with relative temporal sparing
  97. What eye findings can thioridazine cause?
    severe retinopathy
  98. What is Charles Bonnet Syndrome?
    where patients with vision loss see things in the space where vision is lost.
  99. What characterizes Dementia with Lewy Bodies?
    • - degenerative dementia
    • - fluctuating levels of alertness
    • - visual hallucinations
    • - parkinsonian features
    • - sensitivity to neuroleptics
  100. in patients with epilepsy, where do formed visual auras arise from?
    temporal-occipital region
  101. in patients with epilepsy, where do simple, unformed visuals auras arise from? (like flashing lights)
    occipital lobe
  102. what can nacolepsy be associated with?
    hypnopompic or hypnagogic hallucinations
  103. What are peduncular hallucinosis?
    vivid images seen following midbrain injury
  104. What is the most common genetic cause of visual impairment?
    Leber congenital amaurosis
  105. What part of the eye has the highest visual acuity?
    the fovea

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