Oc Dz exam 1
Terms
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- Benign Episodic Pupillary Mydriasis
- episodic unilateral mydriasis last mins to weeks; often female; headache often associated; decrease accommodation; no Signs of EOM/LID involvement
- Physiological anisocoria
- normal light rxn; normal near rxn; difference in size bet. 2 pupils same in light/dark (<1mm);vary day to day; can switch sides
- Horner's syndrome
- miosis of affected pupil; ptosis of Upper lid; enophthalmosis; anhydrosis of the AFFECTED side of face
- Cocaine Test
- Normal pupil-->dilates; + Horner's --> no dilation
- Hydroxyamphetamine Test
- Normal pupil --> dilates; + Horner's (1st/2nd)--> dilates; +Horner's (3rd)--> No dilation
- Congenital Horners
- heterochromia of affected iris (lighter); lack of lid fold; FAT scan shows presence as child
- Apraclonidine Test
- Normal pupil --> NO dilation; Horner's (1st/2nd/3rd): Dilation (anisocoria reversed)
- 1st order Horner's cause
- CVA; Wallenberg's syndrome; neck trauma; neoplasm; (MS) demyelinating disease
- 2nd order Horner's cause
- neoplasm (lung carcinoma; thyroid adenoma; metastasis; (Phrenic nerve syndrome; Pancoast tumor) neck trauma; surgery(thyroidectomy, radical neck sx, carotid angiography
- 3rd order Horner's cause
- headache assoc;internal cartotid dissection;Herpes Zoster;Otitis media; Tolosa-Hunt Syndrome;nasopharyngeal carcinoma;idiopathic: atherosclerosis in elderly
- Horner's differential Dx
- 1.Trauma 2. Age-related levator dehiscence; 3. Dermatochalasis
- Argyll Robertson Pupils
- miotic, irregular shape; bilateral but often asymmetric, Poor light response; Brisk near response; normal va; poor dilation; iris atrophy;
- Tonic Pupils
- irregularly dilated pupil -->sectoral paralysis of sphincter, stromal streaming, stromal spread; slow constriction to converge to bilateral;young to middle age women; DEEP TENDON REFLEXES absent on Ipsilateral side
- Pilocarpine Test
- Normal pupil--> NONE to min. constriction; Adie's Pupil--> Constriciton due to cholinergic supersensitivity-->not present in acute phase
- Adie's Tonic Pupil causes
- idiopathic; orbital trauma/infection; herpes zoster; diabetes;syphilis (bilateral)
- Site of lesion of Adie's
- ciliary ganglion; dorsal root of spinal cord if decreased tendon reflex
- Site of lesion of Argyll Robertson
- Sylvian aqueduct at level of ROSTRAL midbrain interfering w/ light reflex fibers & supernuclear inh. fibers of EW
- 3rd nerve Palsy
- ptosis of ipsilateral side; EOM palsies (MR, IR, IO, SR) ; PUPIL constricts to 1% pilo (local effect)
- Light Near Dissociation Syndrome causes
- optic neuropathy/severe retinopathy; Argyll Robertson pupil; Longstanding diabetes; aberrant regeneration (CN 3; Adies tonic pupil); Dorsal midbrain Syndrome(Parinaud's syndrome)
- Parinaud's syndrome
- deficient UPward gaze; retraction-convergence "nystagmus" on upgaze; mid-dilated LND pupils; CN4 palsy;
- Site of lesion of Parinaud
- level of dorsal midbrain: elderly--> midbrain infarct; young/middle age--> pinealoma
- Collier's sign
- lid retraction bilateral lids go up ang gets nystagmus; can be asymmetrical
- Valsalva maneuver
- raises venous pressure, transient proptosis increase, av malformations, carotid-cavernous fistula, & orbital bony defects
- Cogan lid twitch
- pt look down for 20-30 secs, then look in 1 gaze upper lids overshoot & then come back to normal position
- Peak sign
- orbicularis weakness; close eye gently, look for one lid opening up slightly & asymmetry between the 2 lids
- Ophthalmoparesis
- CN 3.4 6,paralysis Diplopia worse in PM; OKN nystagmus in ADDuction deficit eye
- BINO
- not able to Induce OKN nystagmus in ADDuction deficit eye only in ABDuction (bilateral internuclear ophthalmoparesis)-->unilateral (ischemic attack)
- Ice Pack test
- induce ptosis & measure; apply ice pack w/in 10 seconds if MG, ptosis improves
- Tensilon test
- inject .2cc to see if MG better, inject another .2cc if not better, inject .6cc remainder; diplopia gets better EOM paresis & ptosis improves it is MG. need IV atropine for respiratory /cardiac failure
- Mestinon
- pyridostigmine bromide -->anticholinesterase medication
- Prostigmin
- neostigmine chloride-->anticholinesterase medication
- Immunosuppressives
- azathioprine,cyclosporine,mycophenolate,cyclophosphamide
- Corticosteroids
- concurrently used with mestinon & prostigmin