Board Certified Ophthalmologist FREE 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

Sudden painless vision loss with disc swelling and peripapillary hemorrhages in a middle-aged patient is classic for non-arteritic anterior ischemic optic neuropathy (NAION).

Question 2

Which cranial nerve palsy is most commonly associated with microvascular ischemia in a diabetic patient and typically resolves spontaneously within 3 months?

Accepted Answer

Cranial nerve III

Answer

Microvascular third nerve palsy in diabetics characteristically spares the pupil and resolves spontaneously within approximately 3 months.

Question 3

A patient with multiple sclerosis develops acute painful vision loss in the left eye with dyschromatopsia. MRI shows enhancement of the left optic nerve. What treatment is recommended to hasten visual recovery?

Accepted Answer

Intravenous methylprednisolone

Answer

The Optic Neuritis Treatment Trial demonstrated that IV methylprednisolone hastens visual recovery in optic neuritis, while oral prednisone alone increased recurrence risk.

Question 4

A 70-year-old woman presents with new-onset diplopia, jaw claudication, and an ESR of 95 mm/hr. What is the most critical next step to prevent permanent vision loss?

Accepted Answer

Immediate high-dose systemic corticosteroids

Answer

Giant cell arteritis requires immediate high-dose corticosteroids to prevent irreversible bilateral vision loss; biopsy can be performed after treatment initiation without affecting results for up to two weeks.

Question 5

A patient presents with bilateral optic disc edema, transient visual obscurations, and pulsatile tinnitus. Opening pressure on lumbar puncture is 32 cm H2O. Which visual field defect is most characteristically associated with this condition?

Accepted Answer

Enlarged blind spot

Answer

Idiopathic intracranial hypertension (pseudotumor cerebri) most characteristically causes enlarged blind spots due to papilledema-related expansion of the optic disc.

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