FREE Board Certified Ophthalmologist Neuro-Ophthalmology Questions and Answers Flashcards
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A patient with a known pituitary macroadenoma presents with progressive visual field loss. Which visual field pattern is most expected?
Answer: Bitemporal hemianopia
A pituitary macroadenoma compresses the optic chiasm from below, preferentially damaging the crossing nasal fibers and producing a bitemporal hemianopia.
A 55-year-old patient develops Horner syndrome after a painful episode. Pharmacologic testing with hydroxyamphetamine drops fails to dilate the affected pupil. Where is the lesion localized?
Answer: Third-order (postganglionic) neuron
Hydroxyamphetamine works by releasing norepinephrine from intact postganglionic nerve terminals; failure to dilate indicates a third-order (postganglionic) neuron lesion.
Which condition is characterized by a triad of ophthalmoplegia, ataxia, and confusion and is caused by thiamine deficiency?
Answer: Wernicke encephalopathy
Wernicke encephalopathy presents with the classic triad of ophthalmoplegia, ataxia, and confusion due to thiamine (vitamin B1) deficiency, commonly seen in chronic alcoholism.
A patient presents with bilateral internuclear ophthalmoplegia (INO). In a young adult, what is the most common etiology?
Answer: Multiple sclerosis
Bilateral INO in a young adult is highly suggestive of multiple sclerosis due to demyelinating lesions in the medial longitudinal fasciculus.
A 60-year-old patient presents with sudden onset of vertical diplopia that worsens on downgaze and head tilt to the affected side. The Bielschowsky head tilt test is positive. Which cranial nerve is most likely affected?
Answer: Cranial nerve IV (trochlear)
A positive Bielschowsky head tilt test with vertical diplopia worsening on downgaze and ipsilateral head tilt is pathognomonic for a fourth cranial nerve (trochlear) palsy.
A patient with thyroid eye disease presents with restricted upgaze and elevated intraocular pressure on upgaze. Which extraocular muscle is most commonly affected in this condition?
Answer: Inferior rectus
The inferior rectus is the most commonly affected extraocular muscle in thyroid eye disease, and its fibrotic enlargement restricts upgaze and increases IOP in that gaze position.