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Neuro-ophthalmology Illustrated Chapter 12 – The Pupil 2

October 16, 2019 By

Questions:
  5. Which order neuron is involved when the Horner syndrome is caused by a tumor in the apex of a lung?
  6. Do patients with a third-order Horner syndrome usually have anhidrosis?
  7. What neurotransmitter is released at the neuromuscular junction that results in pupillary constriction?
  8. What neurotransmitter is released at the neuromuscular junction that results in pupillary dilation?
  9. Why do lesions of the geniculate nucleus, the optic radiations, or the visual cortex not affect pupillary size or pupillary reactivity?
10. What is the course of the parasympathetic fibers for pupillary constriction from the Edinger-Westphal nucleus to the ciliary ganglion?
11. What is the ratio of postganglionic parasympathetic fibers that innervate the ciliary muscle to those that innervate the pupillary sphincter muscle?
12. What specific steps should be followed in examining a patient with anisocoria?

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Neuro-ophthalmology Illustrated Chapter 12 – The Pupil 1

October 10, 2019 By

Questions:
1. When examining the pupils, what 6 items should be recorded?
2. Does a relative afferent pupillary defect cause anisocoria?
3. If there is no relative afferent pupillary defect in a patient is suspected of having optic neuropathy (regardless of the cause) does that rule-out this diagnosis?
4. If a patient has severe bilateral optic neuropathy will the pupils respond to near stimuli?

Neuro-ophthalmology Illustrated Chapter 11 – Abnormal Visual Perceptions: Hallucinations and Illusions 4

October 10, 2019 By

Questions:
42. What are the common hallucinogens?
43. What common hallucinogen can be responsible for delayed impressions of déjà vu or flashbacks that may occur years after even a single-use?
44. Are all anticholinergic agents (including atropine, scopolamine, and cyclopentolate) hallucinogens?
45. What antiparkinsonian agents can cause hallucinations?
46. Can antidepressants cause hallucinations?
47. Can antipsychotics cause hallucinations?
48. What is the visual symptom of toxic levels of Digoxin?
49. Can erectile dysfunction medications cause hallucinations?
50. Can withdrawal from benzodiazepines produce hallucinations?

Neuro-ophthalmology Illustrated Chapter 11 – Abnormal Visual Perceptions: Hallucinations and Illusions 3

September 25, 2019 By

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

September 18, 2019 By

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 11 – Abnormal Visual Perceptions: Hallucinations and Illusions 2

September 11, 2019 By

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 1 – Examination 3

November 14, 2018 By

Questions:

11. Which 5 features of pupil function should be documented in a neuro-ophthalmic examination?

12. Would a Relative Afferent Pupillary Defect be expected with anisocoria?

13. Does an occipital lobe injury result in a Relative Afferent Pupillary Defect?

14. Does a unilateral optic neuropathy result in a Relative Afferent Pupillary Defect?

15. Can a unilateral optic tract lesion result in a Relative Afferent Pupillary Defect?

16. What anatomic factor explains the Relative Afferent Pupillary Defect with an optic tract lesion?

Recommended Reading – The expanding burden of idiopathic intracranial hypertension

November 7, 2018 By

Recommended Reading – The expanding burden of idiopathic intracranial hypertension

The expanding burden of idiopathic intracranial hypertension
Susan P. Mollan, Magda Aguiar, Felicity Evison, Emma Frew & Alexandra J. Sinclair. Eye (2018)

Free Full Text: https://www.nature.com/articles/s41433-018-0238-5

Abstract
OBJECTIVE: To quantify the hospital burden and health economic impact of idiopathic intracranial hypertension.

METHODS: Hospital Episode Statistics (HES) national data was extracted between 1st January 2002 and 31st December 2016. All those within England with a diagnosis of idiopathic intracranial hypertension were included. Those with secondary causes of raised intracranial pressure such as tumours, hydrocephalus and cerebral venous sinus thrombosis were excluded.

RESULTS: A total of 23,182 new IIH cases were diagnosed. Fifty-two percent resided in the most socially deprived areas (quintiles 1 and 2). Incidence rose between 2002 and 2016 from 2.3 to 4.7 per 100,000 in the general population. Peak incidence occurred in females aged 25 (15.2 per 100,000). 91.6% were treated medically, 7.6% had a cerebrospinal fluid diversion procedure, 0.7% underwent bariatric surgery and 0.1% had optic nerve sheath fenestration. Elective caesarean sections rates were significantly higher in IIH (16%) compared to the general population (9%), p < 0.005. Admission rates rose by 442% between 2002 and 2014, with 38% having repeated admissions in the year following diagnosis. Duration of hospital admission was 2.7 days (8.8 days for those having CSF diversion procedures). Costs rose from £9.2 to £50 million per annum over the study period with costs forecasts of £462 million per annum by 2030.

CONCLUSIONS: IIH incidence is rising (by greater than 100% over the study), highest in areas of social deprivation and mirroring obesity trends. Readmissions rates are high and growing yearly. The escalating population and financial burden of IIH has wide reaching implications for the health care system.

Composite figure.


a Incidence in the general population. b Incidence by age and gender. c Annual incidence in females and males and Obesity rates (% obesity per annum (body mass index ≥ 30), age-standardized in 18 years + by gender in the United Kingdom. From World Health organisation http://apps.who.int/gho/data/node.main.A900A?lang=en Accessed 6 Oct 2017. d Management of IIH in the cohort. e Geographical distribution of diagnosed cases of IIH in England. F Distribution of cases by region per annum.

 

Neuro-ophthalmology Illustrated Chapter 1 – Examination 2

November 7, 2018 By

Questions:
4. For the Photostress Recovery Test, how long does the patient look at a bright light held a few centimeters from the eye?
5 For the Photostress Recovery Test, what is the recovery end point to observe?
6. For the Photostress Recovery Test, what is the normal recovery time?
7. Which conditions prolong the recovery time of the Photostress Recovery Test?
8. What is the normal height of the palpebral fissure?
9. What is the normal Marginal Reflex Distance (MRD1)?
10. How many millimeters is the normal levator function measurement?

Neuro-ophthalmology Illustrated Chapter 1 – Examination 1

October 31, 2018 By

Questions:
1. What is the minimum visual acuity needed to correctly read the control plate on the color vision testing plates?
2. Which is the more sensitive color vision test, Hardy-Rand-Rittler or Ishihara for optic neuropathy?
3. What are the causes of acquired unilateral or bilateral reduced color vision?