OphthoBook-Question – Neurology

Diagnoses is by symptoms (temple pain, jaw claudication, polymyalgias, malaise), labs (ESR, CRP, PLT) and temporal artery biopsy. Treatment is steroids.

This is simply a relative afferent pupillary defect (RAPD).

This is loss of sympathetic tone to the eye that makes the pupil small. It can be caused by tumors or lesions along the sympathetic chain.

An Adie’s pupil is a dilated pupil caused by paralysis of the parasympathetics that normally constrict the pupil.

CT is best for orbit and bone injuries. MRI is best for looking at the brain.

The 4-4 rule can be used to figure out the location of the nuclei. You’ll need to click the more button to figure this one out.

You need to consider multiple sclerosis and order an MRI to look for demyelinating lesions.

Loss of vision, decreased color vision and contrast sensitivity. Central vision loss is common and some pt’s have pain with eye movement.

A 3rd nerve palsy with pupil involvement implies a compressive lesion (such as an an aneurysm or tumor) pushing on the nerve.

6th nerve palsies make the eye turn inward and can occur from HTN, DM, tumor, and high intracranial pressure.

4th nerve palsies are hard to detect. They cause a mild vertical diplopia and can occur from DM, HTN, tumor, congenital damage, and mild head trauma.

3rd nerve palsies make the eye turn down and out. Causes include DM and HTN. A blown pupil implies tumor or aneurysm.

Whether the diplopia is monocular (astigmatism or cataract) or binocular (nerve palsies, etc.)

Headaches, scalp tenderness, malaise, weight loss, night sweats, fevers, jaw claudication and muscle aches.