question

Papilitis

answer

Loss of physiological 'central cup' visual acuity severely affected due to associated inflamation of the optic nerve (retrobulbar neuritis)

question

Papiloedema

answer

does not affect visual acuity (unless macular area is affected by hemorrhage) although the blind spot is enlarged

question

A loss of retinal colour (becomes milky white) and macular blush could indicate

answer

Central retinal artery occlusion

question

Hypertensive retinopathy

answer

superficial heamorrhage and 'cotton wool' exudates

question

Psuedopapilloedema (Drusen)

answer

hyaline bodies near the optic disc which raise the disc and blur the margin. This normal variant may be inherited

question

Optic atrophy

answer

Disc white like a 'tennis ball' with 'punched out' margins: blood supply is less prominent and the number of arteries reduced

question

Retinitis pigmentosa

answer

Pigmentary deposits in the periphery of the retina

question

Choroiditis

answer

Areas of white sclera exposed along with areas of proliferation of retinal pigmentary epithelium- follows atrophy of the choroid Occurs in toxoplasmosis and cytomegalovirus infection

question

Diabetic retinopathy

answer

Small deep haemorrhages and hard exudates in a long-standing diabetic

question

Malignant melanoma

answer

Dark oval mass- possibly related to secondary retinal detachment- in middle aged patient

question

Retinoblastoma

answer

White mass behind the pupil- in infancy

question

Centro-caecal scotoma

answer

the scotoma extends to involves the blind spot. Characteristic of toxic amblyopia- alcohol, tobacco

question

Arcuate scotoma

answer

The scotoma extends fom the blind spot following the course of nerve fibres. Characteristic of glaucoma; seen also in small lesion close to the optic disc such as choroiditis

question

Junctional scotoma

answer

indicates the presence of an optic nerve lesion immediately anterior to the chiasma

question

Involvement of the upper quadrants first indicates compressing of the optic chiasma from below suggests...

answer

-pituitary adenoma -nasopharyngeal -carcinoma -sphenoid sinus mucolele you want to skull x-ray/CT/MRI

question

Involvement of the lower quadrants first indicates compression if the optic chiasma from above and suggests...

answer

-craniopharyngioma -third ventricular tumor You'll want to CT/MRI

question

Homonymous hemianopia

answer

An incongruous homonymous hemianopia (one eye affected more than the other) suggests a compressive lesion of the optic tract near the chiasma -vascular cause -tumor (gradual onset)

question

Horners syndrome may cause

answer

-Miosis -ptosis -Disturbance of sweating

question

Horner's syndrome may result from damage at the following sites

answer

Brain stem cervical cord middle fossa internal carotid artery cervical sympathetic chain anterior roots C8, T1

question

Right sided Horner's preganglionic lesion

answer

cocaine acts at the adreneric nerve endings and, by preventing adrenaline uptake, causes pupil dilation when the lesion is preganglionic

question

Right sided horner's postganglionic lesions

answer

When the lesion if postganglionic, cocaine has little affect because there are no nerve endings on which the drug may act.

question

Clinical assesment of impaired vision

answer

1. Examine the orbits -proptosis(forward displacement of the globe) -globe fixation 2. Examine ocular movement -Differentiate (Concomitant, paralytic)

question

When examining the ocular movement it is important to note

answer

The presence of a squint or strabismus

question

Concomitant squint

answer

Heterotropia an ocular diorder, a deviation is present in all gaze directions. Squint develops before binocular vision is established. Usually there are convergent (esotropia), occasionally divergent (extropia) ABSENCE of diplopia

question

Paralytic squint

answer

-affected eye shows limited movement -angle of eye deviation and diplopia greatest when looking in the direction controlled by the weak muscle -Diploia ALWAYS present -Patient may tilt head to minimise the diplopia

question

Difference in ptosis of III nerve lesion and Horner's syndrome

answer

In III nerve lesion the ptosis may be complete, unlike the partial ptosis of a Horner's syndrome which disappears on looking up

question

III Nerve Lesion, in the primary position

answer

The affect eye deviates laterally (due to unopposed action of the lateral rectus) and ptosis and pupil dilation are evident

question

IV Nerve Lesion recognition

answer

Eye apearns normal except in adduction position where it reveals defective depression

question

Symptoms of IV Nerve lesion

answer

Patient complains of double vision when looking down or reading. Head may tilt to the side opposite to the weak superior oblique to minimise diplopia.

question

VI Nerve Lesion recognition

answer

Appear normal in primary position. Looking to paralysed side there is a failure of abduction of the affected eye

question

Diplopia of VI Nerve

answer

Its horizontal, present only when looking to the paralysed side and is maximal at the extreme binocular lateral vision.

question

Signs of Myasthenia gravis and Ocular myopathy when looking at ocular muscles

answer

-involvement of extraocular muscles (levator palpebrae superioris, rbicularis oculi) -sign of fatigue on repeated testing

question

Conjugate deviation occurring during a seizure

answer

wrong way eyes eyes deviate towards the affected limbs in a jerking fashion

question

Conjugate deviation occurring during a seizure indicates

answer

An epileptic focus in the frontal lobe contralateral to the direction of eye deviation

question

Conjugate deviation accompanying a hemiparesis (tonic deviation away from hemiparesis) indicates

answer

Right way eyes Indicates a lesion in the frontal lobe ipsilateral to the direction of eye deviation

question

Cause of wrong way eyes

answer

Hemorrhage deep in the cerebral hemisphere (thalamic) can cause deviation of eyes to the side of hemiparesis

question

Tonic deviation of the eyes towards the hemiparetic limb

answer

Wrong way eyes usually indicates a lesion in the pons contralateral to the direction of eye deviation and results from damage to the paramedic pontine reticular formation (PPRF)

question

Vertical gaze palsy

answer

-midbrain or pontine lesion -causes failure of upward or downward gaze

question

Downward gaze occurs with

answer

periaqueductal (Sylvian aqueduct) lesions

question

Impaired vertical eye movement is common in

answer

Extrapyramidal disease (Progressive supranuclear palsy)

question

Parinaud's Syndrome is characterized by

answer

Impaired upward eye movements in association with a dorsal midbrain lesion -upward gaze and convergence are lost -the pupils may dilate and the response to light and accomodation is impaired

question

Causes of Parinaud's syndrome

answer

Third ventricular tumors pineal region tumors hydrocephalus MS Wernicke's encephalopathy Encephalitis

question

Internuclear ophthalmoplegia (ataxic nystagmus) is caused by

answer

Damage to the medial longitudinal bundle

question

Internuclear ophthalmoplegia (ataxic nystagmus) is

answer

An internuclear disorder of movement and produces a disconjugate gaze palsy

question

Trigeminal neuralgia (Tic douloureux):

answer

Unilateral pain of the face in one or more divisions of the trigeminal nerve. Unilateral, electric shock-like stabbing pains. Washing, shaving, smoking, talking, and brushing the teeth trigger the pain; minimal/ no sensory loss. Often in a different area of the face from trigger point. Abrupt onset and termination, with Pain-free intervals. Pain restricted to CNV (mainly), CNVII, CNIX and CNX. An elderly disease, 60% women preponderance

question

Pathogenesis of Trigeminal Neuralgia

answer

segmental demyelination and artificial synapse formation at the junction of central and peripheral myelin. e.g.: multiple sclerosis, mechanical and vascular compression or natural aging. Induction of a short circuit with triggers switching it on.

question

Etiology of Trigeminal neuralgia:

answer

Mechanical compression of the trigeminal N. (pons) Cross compression by superior cerebellar artery (pain in 2nd or 3rd trigeminal division). inferior posterior cerebellar, vertebral or inferior anterior cerebellar artery (1st division pain). Vein compression, A-V malformation, tumors, aneurism or demyelinating plaque (multiple sclerosis).

question

Therapy for trigeminal neualgia

answer

1.PHARMACOLOGIC 2.LOCAL ANESTHETIC BLOCK 3.NEUROLYTIC BLOCK (using alcohol) 4.DENTAL PROCEDURES 5.SURGICAL THERAPIES:

question

Drug therapy for trigeminal neuralgia

answer

Carbamazepine (most effective and confirms diagnosis), Baclofen, Lamotrigine, Gabapentin, phenytoin

question

unilateral involvment of the lower face

answer

-indicates a contralateral supranuclear lesion -causes: vascular, tumor, demyelination, infection

question

unilateral involvment of upper and lower face

answer

-indicates an ipsilateral nuclear or infranuclear lesion

question

Bilateral involvent of upper and lower face

answer

-muscle disease (myasthenia gravis, muscluar dystrophy) -Bilateral infranuclear lesions (sarcoidosis, Guillian Barre, Lyme) -Bilateral nuclear lesions(pontine lesions- infarction, haemorrhage, demylination, tumor, infection, syringobulbia, motor neuron disease)

question

Bell's phenomenon

answer

Eyes move outwards and upwards on attempted closure

question

Characteristics of Bell's palsy

answer

An acute paralysis of the face related to 'inflamation and swelling of the facial nerve within the facial canal or at the stylomation foramen on attempting to close the eyes and show the teeth, the one eye does not close and the eyeball rotates upwards and outwards

question

Symptoms of Bell's Palsy

answer

Pain of variable intensity over the ipsilateral mastoid precedes weakness ,develops over 48 hrs -impairment of taste -hyperacusis and salivation depend on the extent of inflammation

question

Diagnosis of Bell's palsy

answer

Based on typical presentation and exclusion of middle ear disease, diabetes, sarcoidosis and Lyme disease

question

Ramsay Hunt Syndrome

answer

Is a herpes zoster infection of the genicukate (facial) ganglion

question

Ramsay Hunt Syndrome causes

answer

Severe facial weakness with a typical zoster vesicular eruption within the external auditory meatus. Seosanguinous fluid may discharge from the ear. Deafness may result from VII involvment.

question

What is a major feature in Ramsay hunt?

answer

Pain is a major feature and may preceed the facial weakness.

question

Treatment for Ramsay Hunt

answer

Antiviral agents (acyclovir) may help

question

Where do bipolar cell bodies lie within the ear?

answer

In the vestibular ganglion

question

Types of deafness

answer

1. Conductive deafness 2. Sensorineural deafness 3. Pure word or cortical deafness

question

Conductive deafness is

answer

failure of sound conduction to the cochlea

question

Sensorineural deafness is

answer

Failure of action potential production or transmission due to disease of the cochlea, cochlear nerve or cochlear central connections

question

Pure word or cortical deafness

answer

A bilateral or dominant posterior temporal lobe (auditory cortex) lesion produces a failure to understand spoken language despite preserved hearing

question

Conductive deafness is associated with

answer

Low pitch tinnitus

question

Sensorineural deafness is associated with

answer

high pitch tinnitus, except Meniere disease where tinnitus is low pitch

question

Pulsing tinnitus is caused

answer

By a vascular cause

question

Diabetic neruopathy damage results from

answer

Either metabolic disturbances with sorbitol and fructose accumulation in axons ans Schwann cells or an occlusion of the nurtient vessels supplying the nerves (vasa vasorum)

question

Upper plexus lesion

answer

(C5C6) Traction on the arm at birth (Erb-Duchenne paralysis) or falling n the shoulder may damage the upper part of the plexus paralysed (deltiod, supraspinatus, infraspinats, biceps, brachialis)

question

Posterior cord syndrome

answer

(C5C6C7C8) Paralysed (deltiod, extensor of elbow, wrist, fingers)

question

Lower plexus lesion

answer

(C8T1) Forced adduction of arm at birth (Klumpke's paralysis) or trauma may produce damage to the lower plexus. Results in paralysis of the intrinsic hand muscles producing a claw had. C8T1 sensory loss and Horner's Syndrome if T1 root involved

Neurology and Neurosurgery Illustrated notes – Flashcards

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards