Neuroophthalmology david kinshuckgoodhope nhs uk a semiinteractive tutorial

Neuro-ophthalmology david. kinshuck@goodhope. nhs. uk a semi-interactive tutorial to be used with the online files; downloaded versions can be downloaded from here into the same folder. They are. exe files and should play on all laptops

Neuro-ophthalmology Dilated pupil/ptosis/divergent eye = 3 rd n palsy Vertical diplopia = 4 th nerve palsy One eye convergent = 6 th nerve palsy 7 th nerve palsy Dilated pupil/normal sight = adies pupil Dim vision one eye = optic neuritis (rarely tumour) Field defects

3 rd nerve palsy Common symptoms, 3 rd button

3 rd nerve palsy

3 rd nerve palsy Online, chronic eye disease, section 3 (3 rd ‘? ’ down on left) 2 mb Folder similar All recti except superior oblique and lateral rectus paralysed

4 th nerve palsy Online, chronic eye disease, section 3 (3 rd ‘? ’ down on left) 2 mb Folder similar Superior oblique palsy: vertical diplopia

6 th nerve palsy Online, chronic eye disease, section 3 (3 rd ‘? ’ down on left) 2 mb Folder similar Lateral rectus palsy

7 th nerve palsy Try and think, in pairs, 1 minute Causes Problems What is the route of the 7 th nerve?

7 th nerve palsy lesions Bells palsy, possibly herpes simplex Ramsay-Hunt with rash: herpes zoster Upper motor neurone…forehead symmetrical Detailed description

7 th nerve palsy Runs over petrous part of temporal bone… 6, 7, 8 th palsy Herpes zoster: look in ear for vesicles

7 th nerve palsy: eye problems Dry cornea can ulcerate Use fluorescein for examination Lubricate +++ Occasionally suture lids closed. Serious problem for acoustic neuroma patients

Nystagmus Involuntary eye movement… Slow movement is the ‘problem’ Fast is the recovery If worse looking straight, generally a central lesion If worse looking to one side, generally vestibular l online (section 12, double vision and pupil, 3 top ‘? ’right) l Folder similar

Optic atrophy Think, again in pairs, about what may cause optic neuritis Infection, genetic, toxic, vascular, nutritional, other diseases

Optic atrophy, photos

Optic atrophy, causes Dim sight Reduced visual field Causes Pernicious anaemia…B 12 deficiency l Congenital. . eg Lebers l Toxic…methanol, smoking, poor diet l

Optic atrophy, case A 43 y woman complains of a mild headache (left forehead). The headache has been present 2 months, and is not getting better. As you listen she tells you the sight is dim in left eye. Examination confirms red colours in the left eye are not as bright as when seen with the right eye. CT scan details: (Further examination may show a pale optic disk and afferent pupillary defect, and visual field defect, but even without these findings a CT scan is needed. )

Field defects Quiz…with each lesion, what would the field draw the field…in pairs. Answers Online (tiny) l folder Here 1 Here 2 Here 3 l Here 4 (small, lower occipital)