Neuro-ophthalmology Illustrated Chapter 19 – Diagnosis of Headache and Facial Pain 2

September 8, 2020 By

Questions:
7. What differentiates classic from symptomatic trigeminal neuralgia?
8. Name several triggers for trigeminal neuralgia?
9. For Classic Trigeminal Neuralgia, what are the:
1. Age range
2. Gender ratio
3. Location of pain
4. Type of pain
5. Duration of pain
6. Temporal pain profile
7. Associated signs
8. Interictal exam
9. Treatment
10. For Symptomatic Trigeminal Neuralgia, what are the:
1. Age range
2. Gender ratio
3. Location of pain
4. Type of pain
5. Duration of pain
6. Temporal pain profile
7. Associated signs
8. Interictal exam
9. Treatment
11. For Cluster (Histamine) Headache, what are the: 
1. Age range
2. Gender ratio
3. Location of pain
4. Type of pain
5. Duration of pain
6. Temporal pain profile
7. Associated signs
8. Interictal exam
9. Treatment
12. For Episodic or Chronic Paroxysmal Hemicrania, what are the:
1. Age range
2. Gender ratio
3. Location of pain
4. Type of pain
5. Duration of pain
6. Temporal pain profile
7. Associated signs
8. Interictal exam
9. Treatment
13. For SUNCT Syndrome (Short-lasting, Unilateral, Neuralgiform headache attacks with Conjunctival injection and Tearing), what are the:
1. Age range
2. Gender ratio
3. Location of pain
4. Type of pain
5. Duration of pain
6. Temporal pain profile
7. Associated signs
8. Interictal exam
9. Treatment
14. For Hemicrania Continua, what are the:
1. Age range
2. Gender ratio
3. Location of pain
4. Type of pain
5. Duration of pain
6. Temporal pain profile
7. Associated signs
8. Interictal exam
9. Treatment

____________________________________________________

Questions with answers:
7. What differentiates classic from symptomatic trigeminal neuralgia?
The classic form is to be considered idiopathic. It includes the cases that are due to a normal artery in contact with the 5th nerve, such as the superior cerebellar artery or even a primitive trigeminal artery. The symptomatic form is not idiopathic and can have multiple origins: aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons. An abnormal vascular course of the superior cerebellar artery is often cited as the cause.

8. Name several triggers for trigeminal neuralgia?
1. Chewing, talking or smiling
2. Drinking cold or hot liquids
3. Touching, shaving, teeth brushing, nose-blowing 
4. Drafts of cold air 

9. For Classic Trigeminal Neuralgia, what are the:
1. Age range: 50-year-old
2. Gender ratio: 1/4
3. Location of pain: Unilateral V2 & V3 > V1
4. Type of pain: Stabbing
5. Duration of pain: <1 second
6. Temporal pain profile: Few to many/day for weeks to months. Pain-free between attacks.
7. Associated signs: No associated signs, look for triggers
8. Interictal exam: Normal
9. Treatment: Carbamazepine (Tegretol) frequent good response

10. For Symptomatic Trigeminal Neuralgia, what are the:
1. Age range: Any
2. Gender ratio: M=F
3. Location of pain: May be bilateral, V1, 2 or 3
4. Type of pain: Dull, persistent
5. Duration of pain: Chronic
6. Temporal pain profile: Fluctuations but no remission
7. Associated signs: 5th nerve hypoesthesia, dysesthesia, and motor deficit
and other cranial nerve palsies 
8. Interictal exam: 5th nerve hypoesthesia and motor deficit
9. Treatment: Variable response to therapy

11. For Cluster (Histamine) Headache, what are the: 
1. Age range: Young
2. Gender ratio: M/F 9/1
3. Location of pain: Unilateral periorbital
4. Type of pain: Boring, very severe
5. Duration of pain: 15-180 minutes
6. Temporal pain profile: 1-8/day, attack phase 4-16 weeks, Remission 6-24 months 
7. Associated signs: Horner syndrome, eye redness, tearing and rhinorrhea
8. Interictal exam: Normal but may have Horner syndrome
9. Treatment: Acute: oxygen, injectable triptans, and DHE, Chronic: lithium, steroids, channel inhibitors-Verapamil (Calan)

12. For Episodic or Chronic Paroxysmal Hemicrania, what are the:
1. Age range: any
2. Gender ratio: M/F 1/3
3. Location of pain: Unilateral periorbital
4. Type of pain: Very severe
5. Duration of pain: 2-30 minutes
6. Temporal pain profile: 5/day
7. Associated signs: Horner syndrome, eye redness, tearing and rhinorrhea
8. Interictal exam: Normal but may have Horner syndrome
9. Treatment: Indomethacin stops pain 

13. For SUNCT Syndrome (Short-lasting, Unilateral, Neuralgiform headache attacks with Conjunctival injection and Tearing), what are the:
1. Age range: Any
2. Gender ratio: M/F 8/1
3. Location of pain: Unilateral periorbital
4. Type of pain: Very severe
5. Duration of pain: 5-240 seconds
6. Temporal pain profile: Numerous in a day, sometimes dull pain between attacks, remissions with an irregular pattern
7. Associated signs: Eye redness and tearing
8. Interictal exam: Normal
9. Treatment: None, variable response (Corticosteroids and the antiepileptic drugs gabapentin, lamotrigine, and carbamazepine may help relieve some symptoms)

14. For Hemicrania Continua, what are the:
1. Age range: Any
2. Gender ratio: M>F
3. Location of pain: Unilateral hemicrania, always same side
4. Type of pain: Sharp pain
5. Duration of pain:  <1 minute
6. Temporal pain profile: Associated with a continuous headache of fluctuating intensity
7. Associated signs: Nausea, vomiting, photophobia and may have Horner syndrome
8. Interictal exam: Normal
9. Treatment: Indomethacin

____________________________________________________

The information below is from Neuro-ophthalmology Illustrated-2nd Edition. Biousse V and Newman NJ. 2012. Thieme

19.4 Differential Diagnosis of Facial Pain
▶Table 19.1 outlines the characteristics of various facial pain syndromes: classic trigeminal neuralgia, symptomatic trigeminal neuralgia, cluster headache, episodic or chronic paroxysmal hemicrania, SUNCT syndrome, and hemicrania continua. In most cases with new-onset facial pain or hemicrania, a workup is required to rule out underlying lesions (e.g., dissections, aneurysms, or cavernous sinus or skull base lesions).

Reference: 1. Neuro-ophthalmology Illustrated-2nd Edition. Biousse V and Newman NJ. 2012. Thieme

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Neuro-ophthalmology Illustrated Chapter 20-Conditions Commonly Encountered in Neuro-ophthalmology 6

August 5, 2020 By

Questions:
49. What are the 4 most common neuro-ophthalmic manifestations of mitochondrial disorders?
50. Name 8 mitochondrial disorders with neuro-ophthalmic manifestations?
51. What are the ophthalmic and systemic manifestations of CPEO (chronic progressive external ophthalmoplegia)?
52. What are the ophthalmic and systemic manifestations of LHON (Leber hereditary optic neuropathy)?

Neuro-ophthalmology Illustrated Chapter 20 – Conditions Commonly Encountered in Neuro-ophthalmology 5

July 29, 2020 By

Questions:
38. What type of iris nodules are present in Neurofibromatosis Type 1, and  Neurofibromatosis Type 2?
39. What are the ocular or CNS manifestations of Neurofibromatosis Type 1?
40. What are the ocular or CNS manifestations of Neurofibromatosis Type 2?
41. What is the classic findings triad in tuberous sclerosis?
42. What is the most prominent ocular manifestation of Tuberous sclerosis?
43. What autosomal dominant condition is associated with multiple, bilateral retinal angiomas and intracranial cerebellar hemangioblastomas?
44. What condition should be suspected in a patient with findings of telangiectasias of the conjunctival vessels and oculomotor apraxia?
45. A patient has an upper eyelid hemangioma, intraocular hypertension, and homonymous hemianopia, what condition is likely to be present?
46. What are the ocular manifestations of Sturge-Weber syndrome?
47. What are the findings of the Wyburn-Mason Syndrome?
48. What are the findings of the Klippel-Trenaunay-Weber Syndrome?

Neuro-ophthalmology Illustrated Chapter 20 – Conditions Commonly Encountered in Neuro-ophthalmology 4

July 22, 2020 By

Questions:
34. A patient has infectious meningitis with severe papilledema. What risk does this pose and what treatment is appropriate?
35. A patient presents with slowly progressive memory loss, cognitive impairment, oculomasticatory movements (myorhythmia), supranuclear vertical gaze palsy. What curable condition should be considered and what lab tests can be used to make the diagnosis?
36. What are 3 classic causes of raised ICP in a patient with known cancer? 37. What are the neuro-ophthalmic manifestations of paraneoplastic syndromes?

Neuro-ophthalmology Illustrated Chapter 20 – Conditions Commonly Encountered in Neuro-ophthalmology 3

July 15, 2020 By

Questions:
27. Multiple sclerosis is more common in:
1. Men or Women? 
2. African-Americans, Caucasians, or Hispanics?
28. What is Lhermitte sign and is it a classic finding in Multiple sclerosis?
29. What are the common eye symptoms of multiple sclerosis?
30. What is the 15-year risk of multiple sclerosis after an initial episode of optic neuritis:
1. overall 
2. with no MRI lesions
3. with 1 MRI lesions 
4. with 2 MRI lesions
5. with ≥ 3 MRI lesions
31. How common is mild-to-severe eye pain in optic neuritis?
32. What are the characteristics of Neuromyelitis Optica (Devic disease)?
33. What treatments are useful Neuromyelitis Optica?

Neuro-ophthalmology Illustrated Chapter 20 – Conditions Commonly Encountered in Neuro-ophthalmology 2

July 8, 2020 By

Questions: 
16.  What condition should be considered in any patient over 50 with transient or constant diplopia?
17. What condition should be considered in any patient over 50 with headaches
18. Is Cranial Arteritis common, uncommon, or rare among Blacks, Hispanics, Asians, and Whites?
19. What percent of patients will have premonitory visual symptoms, usually within the week preceding permanent visual loss from Cranial Arteritis?
20. What are the 7 ophthalmic signs in a patient with anterior ischemic optic neuropathy that are highly suggestive of Cranial Arteritis?
21. In what percentage of patients with Cranial Arteritis will the ESR be normal?
22. Is the CRP ever normal in Cranial Arteritis?
23. What other blood tests may be elevated in Cranial Arteritis?
24. How long will patients with Cranial Arteritis generally need to be treated with oral steroids?
25. At what rate should oral prednisone be tapered in Cranial Arteritis?
26. What test is the only test that confirms the diagnosis of temporal arteritis?

Neuro-ophthalmology Illustrated Chapter 20 – Conditions Commonly Encountered in Neuro-ophthalmology 1

July 1, 2020 By

Questions:
1. True or False: The term stroke includes cerebral ischemia (transient ischemic attacks and cerebral infarctions) and cerebral hemorrhage.
2. True or False: Central retinal artery and branch retinal artery occlusions are equivalent to strokes?
3. What are 12 manifestations of carotid disease?
4. What are 4 manifestations of carotid dissection?
5. What are 5 manifestations of carotid or vertebral artery dissections?
6. Is it correct that in most cases of ocular or cerebral ischemia an evaluation for a cause of thrombophilia should be performed?
7. Is it common for multiple types of congenital thrombophilia to coexist in the patient?
8. Does the presence of marked papilledema with cerebral venous thrombosis require prompt treatment to lower the intracranial pressure?
9. What are 5 classic presenting findings of cerebral venous thrombosis?
10. What tests are used to demonstrate the presence of cerebral venous thrombosis?
11. What retinal lesion is present in this image?

https://lh4.googleusercontent.com/Z59G3jneRqH4fwXB3bbKIkTu3B25k2RGVx0diySSf3-B1gQwHhdoSIOzfBrpA7Gu2J4s7yCpHRL6J62jqpdtGvWZZuifw8wNE3zf_RnJu-KV5FFD-RFxTPs8rma5XzeUPK525VWC

12. What retinal lesion is present in this image?

https://lh3.googleusercontent.com/-OHQ1DVpHDmTA9rk38G2OZFn05XPplCNIfXPNNEfvV3kgiTjLQuKaNXD6_KKXUhC1b55sqYl6Ugjnof9Abih9AkXQKkk0PDNFRNZeEiCZFuG60LHTiSGOZwnGRyQg7G3fYuZrtsD

13. What syndrome do these images suggest?

https://lh6.googleusercontent.com/6pMe5yxAnURAN8tUJZpme1HELvydXUvTvWjGb9MXFs0h4l_NXWvlZ5MR1UUKsdDVbUDWRWd1mgwkhOwa2eixbSrjzKGic4cPQiW52TNjsBg6huBNbm1713pT7AIlbI2xwmP-DUbe

14. What are the 4 classic findings of Terson syndrome?
15. What should be suspected in the presence of a patient with the following findings:
a. Headaches
b. Seizures
c. Focal neurological symptoms and signs (transient ischemic attacks,
cerebral infarctions, or cerebral hemorrhages)
d. Altered mental status?

Neuro-ophthalmology Illustrated Chapter 19 – Diagnosis of Headache and Facial Pain 3

June 24, 2020 By

Questions:
15. What should be measured in all patients with headache?
16. What must be ruled out in all patients with headache?
17. What must be measured in all patients with recurrent, unilateral pain localized around the eye?
18. What lab tests should be done in all patients over age 50 with any headache or facial pain?
19. What should be considered and done when a patient presents with a thunderclap headache? 

Neuro-ophthalmology Illustrated Chapter 19 – Diagnosis of Headache and Facial Pain 2

June 17, 2020 By

Questions:
7. What differentiates classic from symptomatic trigeminal neuralgia?

8. Name several triggers for trigeminal neuralgia?

9. For Classic Trigeminal Neuralgia, what are the:
1. Age range
2. Gender ratio
3. Location of pain
4. Type of pain
5. Duration of pain
6. Temporal pain profile
7. Associated signs
8. Interictal exam
9. Treatment

10. For Symptomatic Trigeminal Neuralgia, what are the:
1. Age range
2. Gender ratio
3. Location of pain
4. Type of pain
5. Duration of pain
6. Temporal pain profile
7. Associated signs
8. Interictal exam
9. Treatment

11. For Cluster (Histamine) Headache, what are the: 
1. Age range
2. Gender ratio
3. Location of pain
4. Type of pain
5. Duration of pain
6. Temporal pain profile
7. Associated signs
8. Interictal exam
9. Treatment

12. For Episodic or Chronic Paroxysmal Hemicrania, what are the:
1. Age range
2. Gender ratio
3. Location of pain
4. Type of pain
5. Duration of pain
6. Temporal pain profile
7. Associated signs
8. Interictal exam
9. Treatment

13. For SUNCT Syndrome (Short-lasting, Unilateral, Neuralgiform headache attacks with Conjunctival injection and Tearing), what are the:
1. Age range
2. Gender ratio
3. Location of pain
4. Type of pain
5. Duration of pain
6. Temporal pain profile
7. Associated signs
8. Interictal exam
9. Treatment

14. For Hemicrania Continua, what are the:
1. Age range
2. Gender ratio
3. Location of pain
4. Type of pain
5. Duration of pain
6. Temporal pain profile
7. Associated signs
8. Interictal exam
9. Treatment

Neuro-ophthalmology Illustrated Chapter 19 – Diagnosis of Headache and Facial Pain 1

June 10, 2020 By

Questions:
1. What are the characteristics of a typical migraine aura?
2. What is the longest duration of a typical migraine aura?
3. Does a typical migraine aura develop gradually?
4. What are the characteristics of the most common type of migraine aura?
5. At what point in a migraine with aura attack should vasoconstrictive treatments used to abort the attack be administered (e.g. ergotamine and triptans)?