Neuro-ophthalmology questions of the week: NOI15-Cavernous Sinus and Orbital Vascular Disorders 3

Questions:
12. What are the findings of thrombosis of the cavernous sinus?
13. What is the usual cause of cavernous sinus thrombosis?
14. What should be considered in a patient with apparent orbital cellulitis?
15. What are the major risks of thrombosis of the cavernous sinus?
16. What are 3 very serious complications of cavernous sinus thrombosis?
17. What is the mnemonic for the structures and their position in the cavernous sinus?

Neuro-ophthalmology questions of the week: NOI15-Cavernous Sinus and Orbital Vascular Disorders 2

Questions:
6. What are 10 ocular findings of carotid cavernous fistula?
7. Which of the cranial nerves is most commonly affected by a carotid cavernous fistula?
8. Can mechanical restriction of extraocular muscles occur in carotid cavernous fistula?
9. What diagnosis should be considered in an elderly woman with a mild headache, and elevated intraocular pressure?
10. What should be considered in all patients a bruit accompanying a chronically red eye?
11. When is treatment indicated for carotid cavernous fistulas?

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Neuro-ophthalmology questions of the week: NOI15-Cavernous Sinus and Orbital Vascular Disorders 1

Questions:
1. What signs and symptoms may develop from an aneurysm of the internal carotid artery within the cavernous sinus?
2. What are the characteristics of direct shunts between the internal carotid artery and the cavernous sinus?
3. What are the characteristics of indirect carotid cavernous or dural shunts?
4. Does a carotid cavernous fistula have unilateral or bilateral ocular symptoms?
5. Do carotid cavernous fistulas always have ocular symptoms?

Neuro-ophthalmology questions of the week: NOI14 Orbital Syndrome

Questions:
1. What is the orbital syndrome?
2. What are the common features of the orbital syndrome?
3. What is the most common cause of unilateral or bilateral proptosis?
4. What should be suspected if there is globe displacement with proptosis?
5. Do brain CT and MRI often miss orbital processes?

Neuro-ophthalmology Question of the Week: Anisocoria – Horner syndrome & Heterochromia Iridis

Question: Which of the following are correct?
1. A heterochromia iridis-associated acquired Horner syndrome is usually due to a lesion of the postganglionic neuron (third order).
2. Heterochromia iridis-associated acquired Horner syndrome only occurs in children?
3. In a patient with isolated heterochromia iridis-associated Horner syndrome, the lighter eye is the one with the oculosympathetic paresis.
4. When both Waardenburg and congenital Horner syndromes occur in the same individual the darker iris is the one with the oculosympathetic paresis.

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Neuro-ophthalmology Question of the Week: Anisocoria – Pseudo-Horner Syndrome

Question: Which of the following may reveal that the cause of anisocoria is not Horner syndrome?
1. Slit-lamp exam
2. The degree of anisocoria remains relatively constant in bright and dim illumination.
3. Repeat examinations of the patient on different days.
4. The absence of miosis on attempted near vision.
5. The failure of the pupil to constrict to light but does constrict with attempted near vision.

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Neuro-ophthalmology Questions of the Week: Horner Syndrome & Hydroxyamphetamine

Questions:
1. A positive Hydroxyamphetamine pharmacologic test for Horner Syndrome indicates a problem in which neuron of the sympathetic chain?
a. 1st order neuron (preganglionic)
b. 2nd order neuron (preganglionic)
c. 3rd order neuron (postganglionic)

2. When the difference in dilation is + or < 0.5 mm. how reliable is the Hydroxyamphetamine pharmacologic test for Horner Syndrome?
a. sensitivity of 100% and specificity of 100%
b. sensitivity of 93% and specificity of 83%
c. sensitivity of 83% and specificity of 73%
d.  sensitivity of 73% and specificity of 63

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Neuro-ophthalmology Questions of the Week: Anisocoria – Horner Syndrome & Cocaine

Questions:
1. How much anisocoria is necessary for the diagnosis of Horner’s syndrome to be made using cocaine drops?
a. 0.3 mm
b. 0.5 mm
c. 1.0 mm
d. 1.5 mm

2. What is the approximate mean odds ratio for the Cocaine pharmacologic test for Horner syndrome assuming a postcocaine anisocoria of at least 0.8mm?
a.   10:1
b.  100:1
c. 1,000:1
d. 10,000:1

3. Which of the following races may not dilate well with topical cocaine?
a. Asians
b. African Americans
c. Caucasians
d. Native Americans

4. Does the cocaine test for Horner syndrome result in a positive urinary test for cocaine?
a. Yes
b. No


Fig. 5.3. Right Horner’s Syndrome3

Neuro-ophthalmology Question of the Weeks: Anisocoria – Horner Syndrome Pharmacology

Question:
1.What is the effect of the following agents on the pupils in Horner Syndrome?
Cocaine
Hydroxyamphetamine
Apraclonidine

2. What is  the mechanism of action of each of these agent used to test Horner Syndrome?
Cocaine
Hydroxyamphetamine
Apraclonidine

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Neuro-ophthalmology Questions of the Week: Anisocoria – Horner Syndrome – Dilation Lag

Question:
How often is a dilation lag present in a patient with Horner Syndrome on the initial examination?
1. 100%
2.  85%
3.  70%
4.  50%

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Left-sided dilation lag in a 29-year-old man with Horner’s syndrome caused by a posterior mediastinal ganglioneuroma. Note that the degree of anisocoria is greater after 5 seconds in darkness (top) compared with findings after 15 seconds in darkness (bottom).