Case Studies in Confusion: "I Wasn't Expecting That" - Optometric Education Consultants

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Case Studies in Confusion: “I Wasn’t Expecting That”
Speakers: Joseph Sowka, OD
Hours: 2hrs | 94798-NO

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This course examines numerous neuro-ophthalmic conditions where the course or findings were atypical and unexpected. Conditions discussed include diplopia, giant cell arteritis, occult intracranial mass lesions, and neurologic visual field loss without confirmatory neuroimaging findings. Strategies are presented on how to proceed when a clinical course does not go as expected.

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Quiz

1. Which of the following is not considered a typical risk factor for non-arteritis anterior ischemic optic neuropathy (NAAION)?*

A - Hypertension

B - Sleep apnea

C - Diabetes

D - Autoimmune vasculitis

2. Which of the following is not a clinical characteristic of non-arteritis anterior ischemic optic neuropathy (NAAION)?*

A - Painful

B - Inferior visual field defect

C - Moderate progressive vision loss

D - Unilateral

3. Which of the following will present with a hyperemic swollen optic nerve and a disc at risk?*

A - Compressive meningioma

B - Pituitary adenoma

C - Non-arteritis anterior ischemic optic neuropathy (NAAION)

D - Tolosa Hunt Syndrome

4. What percentage of microvascular cranial nerve palsies are painful?*

A - None are painful

B - 20%

C - 50%

D - 90%

5. Ischemic cranial nerve palsies causing diplopia should have significant clinical improvement at what time period?*

A - 5 days

B - 2 weeks

C - 6 weeks

D - 20 weeks

6. How many presumptive cranial nerve palsies are patients allowed to have simultaneously?*

A - 1

B - 2

C - 3

D - 4

7. Which of the following would not be a commonly recommended test when evaluating older patients with isolated presumptive microvascular palsies?*

A - ESR

B - FTA-ABS

C - Contrast enhanced brain MRI

D - Acetylcholine receptor antibody assay

8. Which of the following is the most common chronic vasculitis in the elderly?*

A - Rheumatoid arthritis

B - Giant cell arteritis (GCA)

C - Polymyalgia rheumatica (PMR)

D - Sjogren’s syndrome

9. What is the incidence of diplopia in patients with giant cell arteritis?*

A - 6%

B - 27%

C - 57%

D - 84%

10. What percentage of diplopia in giant cell arteritis is caused by a cranial neuropathy?*

A - 12%

B - 63%

C - 88%

D - 100%

11. Any acute vision loss in the elderly should be consider what condition until proven otherwise?*

A - Intracranial aneurysm

B - Microvascular ischemia

C - Intracranial mass lesion

D - Giant cell arteritis (GCA)

12. What is the most likely cause of an acute pupil involved cranial nerve 3 palsy?*

A - Aneurysm

B - Ischemia

C - Inflammation

D - Compressive tumor

13. What percentage of cranial nerve 3 palsies overall are caused by aneurysm?*

A - 12%

B - 30%

C - 60%

D - 90%

14. What is the preferred non-invasive imaging for cranial nerve 3 palsy?*

A - Catheter angiography

B - MRI/MRA

C - CT/CTA

D - PET scan

15. What percentage of patients with cranial nerve 3 palsy caused by aneurysm will die within 24 hours?*

A - 7%

B - 20%

C - 50%

D - 90%

16. Planum sphenoidale meningioma comprises what percentage of all intracranial meningiomas?*

A - 2%

B - 10%

C - 25%

D - 40%

17. A left or right hemianopic visual field defect respecting the vertical midline and only affecting one eye is best termed ______.*

A - Quadrantanopia

B - Hemianopia

C - Junctional Scotoma of Traquair

D - Pac Man field

18. A homonymous sectoranopia indicated a lesion in what area?*

A - Lateral geniculate nucleus

B - Parietal lobe

C - Temporal lobe

D - Occipital lobe

19. A bitemporal hemianopic visual field defect indicates a problem at what area?*

A - Parietal lobe

B - Temporal lobe

C - Occipital lobe

D - Optic chiasm

20. A Junctional Scotoma of Traquair is nearly always caused by what condition?*

A - Compressive mass lesion

B - Ischemic infarct

C - Demyelinating disease

D - Hereditary maldevelopment

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Educational Survey

As a result of this lecture, I better understand when to suspect giant cell arteritis:*

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As a result of this lecture, I better understand the diagnosis and management of acute and progressive optic neuropathies:*

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As a result of this lecture, I better understand the diagnosis and management of ischemic cranial nerve palsies:*

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As a result of this lecture, I better understand visual pathways and occult visual field loss:*

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As a result of this lecture, I better understand chiasmopathy:*

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Survey 6

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Case Studies in Confusion: “I Wasn’t Expecting That”

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