Neuro-Ophthalmology Flashcards

Which symptom has the highest positive likelihood ratio for giant cell arteritis?

Answer: Jaw claudication

Jaw claudication is among the most specific clinical features of giant cell arteritis.

Which fellow-eye optic disc feature is the classic structural risk factor for nonarteritic anterior ischemic optic neuropathy?

Answer: Small, crowded disc with little or no cup

The crowded 'disc at risk' predisposes to compartment-like ischemia in NAION.

A 22-year-old man has sequential painless central vision loss with peripapillary telangiectatic microangiopathy and no leakage on fluorescein. Which mitochondrial mutation is most common?

Answer: 11778 (ND4)

The 11778 mutation accounts for most Leber hereditary optic neuropathy cases and has the poorest recovery prognosis.

A congruous right homonymous hemianopia with macular sparing most likely localizes to which area?

Answer: Left occipital lobe

Highly congruous defects with macular sparing are typical of occipital lesions, often a posterior cerebral artery infarct.

A patient develops a left superior homonymous quadrantanopia after neurosurgery. Which structure was damaged?

Answer: Right Meyer loop in the temporal lobe

Meyer loop carries inferior retinal fibers through the temporal lobe, producing a contralateral 'pie in the sky' defect.

A central scotoma in one eye plus a superotemporal field defect in the other eye localizes to which site?

Answer: Junction of the optic nerve and chiasm

A junctional scotoma involves the ipsilateral optic nerve and contralateral inferonasal crossing fibers near the chiasm.

A bitemporal hemianopia that is denser in the superior fields most suggests which lesion?

Answer: Pituitary macroadenoma

Pituitary adenomas compress the chiasm from below, affecting inferior nasal fibers first and producing superior temporal loss.