Questions:
116. What are the characteristic features of toxic and nutritional optic neuropathies?
117. Is visual loss in toxic or nutritional optic neuropathy commonly the result of a single cause?
118. Is treatment by stopping the toxic agent or replacing a missing vitamin that is causing an optic neuropathy usually effective in improving visual function?
119. What are the common toxins linked to optic neuropathies?
120. What are the nutritional causes linked to optic neuropathies?
121. What is the most common agent in toxic optic neuropathy?
122. What are the findings of methanol-related optic neuropathy and what is its course?
123. What are the characteristics of ethylene glycol-related optic neuropathy?
124. What is the most common medication that causes toxic optic neuropathy?
125. What are the characteristics of ethambutol-related optic neuropathy?
126. What are the characteristics of amiodarone-related optic neuropathy?
127. What should be always be excluded when considering the diagnosis of toxic optic neuropathy?
128. What is often the first sign of vitamin B12 deficiency?
129. What are the characteristics of Vitamin B12 deficiency?
Neuro-ophthalmology Illustrated Chapter 8 – Optic Neuropathies 10
Recommended Reading – Abnormal Facial & Ocular Movement Videos
Recommended Reading – Abnormal Facial & Ocular Movement Videos
Short videos of abnormal facial and ocular movement seen in Dr. C.N. Chua’s clinic.
Ophthalmology Videos page 1 http://www.mrcophth.com/vidoes.html
Ophthalmology Videos page 2 http://www.mrcophth.com/videos2.html
From: Success in MRCOphth by Dr. C.N. Chua http://www.mrcophth.com/chua1.html
Recommended Reading – Mystery Case: A young woman with isolated upbeating nystagmus.
Recommended Reading – Mystery Case: A young woman with isolated upbeating nystagmus.
Charlene Ong, Kevin Patel, Erik Musiek, Gregory Van Stavern.
Neurology 2015; 84 (4) RESIDENT AND FELLOW SECTION
http://n.neurology.org/content/84/4/e17.full
ARTICLE
A 15-week pregnant 21-year-old woman initially presented with nausea, vomiting, and abdominal pain. The patient admitted to decreased oral intake over the past 4 weeks, including her prescribed prenatal vitamins. She was hypokalemic with elevated transaminases and gallstone pancreatitis was confirmed by imaging. Prior to cholecystectomy, fetal heart tones were lost and intrauterine fetal demise occurred. The patient underwent dilation and evacuation as well as cholecystectomy. She was discharged home but returned within 1 week with persistent nausea and vomiting. She had no neurologic complaints at the time. Basic metabolic panel on admission was unremarkable. On hospital day 2, she developed oscillopsia. Her examination was remarkable for large amplitude upbeating nystagmus (UBN) in primary position. She had gaze-evoked UBN in all other directions. The amplitude of the UBN increased on upgaze and dampened on downgaze. Smooth pursuit was impaired in all directions and saccades were dysmetric (video https://www.youtube.com/watch?v=b8j3LcwY2ZM).
Extraocular movements were intact with no evidence of ophthalmoplegia. Pupils were equal and reactive, and fundus examination was normal. Reflexes were present and symmetric, and gait was normal. The patient had no deficits on mental status examination. She was oriented to name, date, place, and situation and had no difficulty with complex commands, calculations, or short-term or long-term memory. Language was similarly intact. She demonstrated no ataxia or other focal abnormalities on examination.
Questions for consideration:
1. What is the differential diagnosis with this history and examination?
2. What is the next step in management for this patient? What tests would you order?
Neuro-ophthalmology questions of the week: NOI16-Nystagmus and Other Ocular Oscillations 1 – Basics
Questions:
Nystagmus Basics
1. What 14 features should be assessed in the evaluation of a patient with nystagmus?
2. What are the characteristics of physiologic nystagmus?
3. What are the characteristics, lesion locations, associated conditions, concerns, and treatment for peripheral vestibular nystagmus?
4. What are the characteristics, lesion locations, associated conditions, and concerns for central nystagmus?
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?
_____________________________________
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: NOI13 Diplopia10.3 – Other Eye Movement Abnormalities
Questions:
21. What is the Raymond syndrome?
22. What is the Millard-Gubler syndrome?
23. What is the Foville syndrome?
24. What is the Wallenberg syndrome?
25. What is the Weber syndrome?
26. What is the Nothnagel syndrome?
27. What is Benedikt syndrome?
28. What is the Claude syndrome?
29. What is the top of the basilar syndrome?
30. What systemic disorders can affect the ocular motor cranial nerves?
Neuro-ophthalmology Questions of the Week: NOI13 Diplopia10.2 – Other Eye Movement Abnormalities
Questions:
11. What is the Tolosa-Hunt syndrome?
12. Where do these findings localize the lesion: Nystagmus, skew deviation, ocular tilt reaction, vertigo, lateropulsion, ipsilateral Horner syndrome, cerebellar syndrome, facial hypoesthesia, cranial nerves IX and X, and contralateral pain and thermal hypoesthesia (Wallenberg syndrome)?
13. Where do these findings localize the lesion: 4th nerve palsy with contralateral Horner syndrome?
14. Where do these findings localize the lesion: 3rd nerve palsy with contralateral ptosis and contralateral superior rectus weakness?
15. Where do these findings localize the lesion: 3rd nerve palsy with contralateral hemiparesis (Weber syndrome)?
16. Where do these findings localize the lesion: 3rd nerve palsy and ipsilateral cerebellar ataxia (Nothnagel syndrome)?
17. Where do these findings localize the lesion: 3rd nerve palsy and contralateral tremor (Benedikt syndrome)?
18. Where do these findings localize the lesion: 3rd nerve palsy and contralateral ataxia with tremor (Claude syndrome)?
19. Where do these findings localize the lesion: 3rd nerve palsy with vertical gaze palsy, lid retraction, skew deviation, and convergence nystagmus?
20. Where do these findings localize the lesion: 3rd nerve palsy with depressed mental status?
Neuro-ophthalmology Questions of the Week: NOI13 Diplopia10.1 – Other Eye Movement Abnormalities
Questions:
1. What are the findings of the Locked-in Syndrome?
2. Where is the lesion in the Locked-in Syndrome?
3. What is Ocular Neuromyotonia?
4. What are the symptoms of Ocular Neuromyotonia?
5. What is the usual cause of Ocular Neuromyotonia?
6. Where do these findings localize the lesion: Horizontal gaze palsy with ipsilateral facial palsy?
7. Where do these findings localize the lesion: 6th nerve palsy with contralateral hemiparesis (Raymond syndrome)?
8. Where do these findings localize the lesion: 6th nerve palsy with ipsilateral seventh nerve palsy and contralateral hemiparesis (Millard-Gubler syndrome)?
9. Where do these findings localize the lesion: 6th nerve palsy with ipsilateral seventh nerve palsy, deafness, hypoesthesia, Horner syndrome, contralateral pain and thermal hypoesthesia, ataxia (Foville syndrome)?
10. Where do these findings localize the lesion: 6th nerve palsy with ipsilateral Horner Syndrome?
Neuro-ophthalmology questions of the week: NOI13 Diplopia 9.4 – Internuclear & Supranuclear Lesions
Questions:
38. Where are eye movements initiated?
39. Which of the following can cause a patient to be unable look to the left?
A. Right FEF, B. Left FEF, C. Right PPRF, D. Left PPRF
40. Where are smooth pursuit eye movements generated?
41. What is the function of inputs to the visual system from the vestibular nuclear complexes?
42. What is the cause of skew deviation?