Board Certified Ophthalmologist Board Certified Ophthalmologist Neuro-Ophthalmology Questions and Answers 2

Question 1

A 45-year-old patient presents with sudden painless monocular vision loss and a relative afferent pupillary defect. Fundoscopy reveals a swollen optic disc with peripapillary hemorrhages. What is the most likely diagnosis?

Accepted Answer

Anterior ischemic optic neuropathy

Answer

Anterior ischemic optic neuropathy presents with sudden painless vision loss, RAPD, and a swollen disc with peripapillary hemorrhages, most commonly in patients over 40.

Question 2

Which cranial nerve palsy is most commonly associated with microvascular ischemia in diabetic patients?

Accepted Answer

Sixth nerve palsy

Answer

Sixth cranial nerve palsy is the most common isolated cranial nerve palsy caused by microvascular ischemia, frequently seen in diabetic patients.

Question 3

A patient with multiple sclerosis develops bilateral sequential optic neuritis. MRI of the brain shows periventricular white matter lesions. What visual field defect is most characteristic of optic neuritis?

Accepted Answer

Central scotoma

Answer

Central scotoma is the most common visual field defect in optic neuritis, resulting from inflammation of the central fibers of the optic nerve.

Question 4

A 30-year-old woman presents with transient visual obscurations, bilateral disc edema, and an enlarged blind spot on perimetry. Her BMI is 38. What is the most appropriate initial diagnostic study?

Accepted Answer

MRI brain with MR venography

Answer

MRI with MR venography is essential to rule out cerebral venous sinus thrombosis before diagnosing idiopathic intracranial hypertension in a patient with papilledema.

Question 5

A patient presents with a complete third nerve palsy including pupil involvement after minor head trauma. CT angiography reveals a 7 mm aneurysm. What is the most likely location of this aneurysm?

Accepted Answer

Posterior communicating artery

Answer

Posterior communicating artery aneurysms are the most common cause of a pupil-involving third nerve palsy due to compression of the parasympathetic fibers on the surface of the nerve.

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Board Certified Ophthalmologist Board Certified Ophthalmologist Neuro-Ophthalmology Questions and Answers 2