Questions:
47. Which cranial nerve passes through the Dorello canal beneath the petroclinoid (Gruber) ligament?
48. Where is the nucleus for the 6th cranial nerve located?
49. What are the clinical findings of a unilateral 6th nerve nuclear lesion?
50. Why does a unilateral nuclear 6th nerve palsy cause an ipsilateral horizontal gaze palsy?
51. Why is a unilateral 6th nerve palsy often accompanied by an ipsilateral 7th nerve palsy?
52. Where is the lesion in a patient with an ipsilateral Horner syndrome and 6th nerve palsy?
53. Where is the lesion in a patient with an ipsilateral Horner syndrome, 6th nerve palsy associated with 3rd nerve, 4th nerve, V1 and V2 deficits?
54. A microvascular 6th nerve palsy is suspected because the 60-year-old patient has diabetes, hypertension, and hyperlipidemia what tests should be done?
55. A presumed microvascular 6th nerve palsy is suspected in the 60-year-old patient with diabetes, hypertension and hyperlipidemia has not resolved within 3-6 months, what test should be ordered?
56. What explains the findings of Duane syndrome?
57. What are the findings of Duane syndrome?
58. Are systemic associations common in Duane syndrome?
59. What is Möbius syndrome?
60. What should be done in a patient with bilateral 6th nerve palsies and a normal MRI?
Neuro-ophthalmology Illustrated Chapter 13 – 4 – 6th Nerve Palsy
Neuro-ophthalmology Illustrated Chapter 13 – Diplopia 3 – Binocular Diplopia
Questions:
29. In a comatose patient, you observe dysconjugate horizontal eye movements when the head is rotated from side to side. What does this suggest?
30. What is the most common cause of unilateral proptosis?
31. What is the most common cause of bilateral proptosis?
32. Which is the most commonly involved extraocular muscle in thyroid eye disease?
33. What is the differential diagnosis of enlarged extraocular muscles?
34. On CT or MRI, which condition spares the insertions of the extraocular muscles, thyroid eye disease or idiopathic orbital inflammation (orbital pseudotumor)?
35. What 4 features differentiate idiopathic orbital inflammation (orbital pseudotumor) from thyroid eye disease?
36. When should a biopsy be done in a patient with presumed “myositis”
37. What tests should be done in all patients over age 50 with transient or permanent diplopia?
38. What is the Silent Sinus Syndrome?
39. What is the Kearns-Sayre syndrome?
40. What are 5 mitochondrial diseases that can have ophthalmoplegia?
41. What are the features of Myotonic Dystrophy?
42. What are 5 features of Oculopharyngeal Dystrophy?
43. What 3 conditions other than paresis or restriction should be considered in any adult with new-onset transient or permanent ocular misalignment?
44. What may induce myasthenia gravis or make it worse?
45. What is the mechanism of action of edrophonium?
46. What are the side effects of the Tensilon test?
47. What does the development of lid retraction in a patient with Myasthenia suggest?
Neuro-ophthalmology Illustrated Chapter 12 – The Pupil 4
Questions:
32. What are ocular disorders that keep a large pupil from constricting?
33. How does one test for pharmacologic mydriasis from topical agents?
34. What are two conditions that cause mydriasis via the parasympathetic nervous system?
35. What are the clinical symptoms and signs of Adie tonic pupil?
36. What explains the light-near dissociation classically found in Adie tonic pupil syndrome?
37. What topical drop is used to confirm the presence of Adie pupil syndrome?
38. Is isolated mydriasis likely to be caused by a third nerve paresis?
39. What may happen to the size of the pupil over time in the Adie syndrome?
40. Do all third nerve paresis have pupillary involvement?
41. What may the workup for an isolated third nerve palsy with mydriasis reveal?
Neuro-ophthalmology Illustrated Chapter 12 – The Pupil 3
Questions:
13. What are the characteristics of physiologic anisocoria?
14. What are the ocular causes of anisocoria?
15. What are the signs of Horner Syndrome?
16. What neurologic symptoms and signs can be associated with Horner syndrome?
17. Which eye drops can be used to establish the diagnosis of Horner syndrome?
18. What is the mechanism of action of cocaine when used to test Horner syndrome?
19. What is observed when testing for Horner syndrome with cocaine?
20. What is the mechanism of action of apraclonidine when used to test Horner syndrome?
21. What is observed when testing for Horner syndrome with apraclonidine?
22. What eye drop is used to localize which order neuron is involved in Horner syndrome?
23. What is the mechanism of hydroxyamphetamine when used to test Horner syndrome?
24. What is observed when hydroxyamphetamine is used to test Horner syndrome?
25. What is the classic cause of a first-order neuron Horner syndrome?
26. What does the combination of an ipsilateral Horner syndrome (first-order) and contralateral superior oblique palsy (fourth nerve palsy) suggest?
27. What does the combination of an ipsilateral Horner syndrome (third-order) and an abducens paresis (sixth nerve palsy) suggest?
28. What should be the presumed cause of an acute painful Horner syndrome?
29. If the localization of a Horner syndrome is unknown what imaging tests should be done?
30. In a young child with an isolated Horner syndrome, a workup should be done for what condition?
31. What tests should be done in a child with a Horner syndrome without a surgical history to explain it?
Neuro-ophthalmology Illustrated Chapter 11 – Abnormal Visual Perceptions: Hallucinations and Illusions 3
Questions:
26. What is palinopsia?
27. What is polyopia?
28. Does the diplopia of polyopia resolve with the closing of either eye?
29. Does the diplopia of polyopia improve with pinhole glasses?
30. What is dysmetropsia?
31. What is the Alice in Wonderland syndrome?
32. What is visual allesthesia?
33. What lesion is most often seen in visual allesthesia?
34. What is the Riddoch Phenomenon?
35. What is Blindsight?
36. What is Residual Vision?
37. What may cause blindsight and residual vision?
38. What are the characteristics of the sensation of environment tilt?
39. What 5 conditions are associated with oscillopsia?
40. What is the Anton Syndrome?
41. What is postoperative delirium?
Neuro-ophthalmology Illustrated Chapter 11 – Abnormal Visual Perceptions: Hallucinations and Illusions 2
Questions:
13. Is the visual aura of migraine a hallucination?
14. What is the typical duration of the visual aura episodes of migraine?
15. What are the characteristics of recurrences of the visual aura of migraine?
16. What is the typical duration of the visual phenomenon of occipital seizures?
17. What other neurologic symptoms can migraineurs have?
18. Are migraineurs aware that the images they see are not real?
19. Can migraineurs experience distortion of images?
20. How are occipital seizures frequently described?
21. What are the characteristics of recurrences of occipital seizures?
22. What is peduncular hallucinosis?
23. What lesion is most often related to peduncular hallucinosis?
24. What are the common visual symptoms of narcolepsy?
25. What is the classic tetrad of narcolepsy?
Neuro-ophthalmology Illustrated Chapter 10 – Specific Disorders of Higher Cortical Function 8
Questions:
61. What are the clinical characteristics of posterior cortical atrophy?
62. What are the neuroimaging findings in posterior cortical atrophy?
63. What are common etiologies of posterior cortical atrophy?
64. What visual difficulties are commonly seen in Alzheimer disease?
65. What are the neuroimaging findings in Alzheimer disease?
66. What are the OCT findings in Alzheimer disease?
67. What visual difficulties are commonly seen in the Heidenhain variant of sporadic Creutzfeldt-Jakob disease?
Neuro-ophthalmology Illustrated Chapter 10 – Specific Disorders of Higher Cortical Function 7
Questions:
44. Where is the lesion usually located in the Balint Syndrome?
45. What are the findings of the Balint Syndrome?
46. What is the Gerstmann syndrome and where is its lesion?
47. Where the lesion is usually located in Hemineglect?
48. Are patients with Hemineglect aware of their defect?
49. Are patients with Hemianopia aware of their defect?
50. What is the response when a patient with a left homonymous hemianopia with unilateral spatial neglect is asked to bisect a line?
51. What is the response when a patient with a right homonymous hemianopia without unilateral spatial neglect is asked to bisect a line?
52. What is the response when a patient with a left Hemianopia with unilateral spatial neglect is asked to draw a clock?
53. What is the response when a patient with a right Hemianopia without unilateral spatial neglect is asked to draw a clock?
54. In a patient with left homonymous hemianopia with unilateral spatial neglect is the exploration of space increased or decreased?
55. In a patient with right homonymous hemianopia without unilateral spatial neglect is the exploration of space increased or decreased?
56. In a patient with left homonymous hemianopia with unilateral spatial neglect are contralesional saccades increased or decreased?
57. In a patient with right homonymous hemianopia without unilateral spatial neglect are contralesional saccades increased or decreased?
58. What differences will be observed between hemineglect and hemianopia in searching for objects?
59. What are the differences between lesion location of hemineglect and hemianopia?
60. What are common factors in cerebral disturbances of vision?
Neuro-ophthalmology Illustrated Chapter 10 – Specific Disorders of Higher Cortical Function 6
Questions:
38. What is ocular apraxia?
39. How does one test for ocular apraxia?
40. What clinical signs are associated with ocular apraxia?
41. What is optic ataxia (visuomotor ataxia)?
42. How does one test for optic ataxia?
43. What clinical signs are associated with optic ataxia?
Neuro-ophthalmology Illustrated Chapter 10 – Specific Disorders of Higher Cortical Function 5
Questions:
31. What is akinetopsia?
32. How does one test for akinetopsia?
33. Where is the lesion in akinetopsia?
34. What is simultagnosia?
35. How does one test for simultagnosia?
36. What clinical signs are associated with simultagnosia?
37. Where is the lesion in simultagnosia?