Neural Pearls

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Neural Pearls
Speakers: Joseph Sowka, OD, FAAO
Hours: 2hrs | 89379-NO

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This course details in a case-based format the symptoms and clinical findings in patients with numerous clinical neuro-ophthalmic entities including Horner syndrome, pupil abnormalities, pituitary apoplexy, and giant cell arteritis. This course identifies the true neuro-ophthalmic urgencies and emergencies and provides numerous clinical pearls that practitioners can use to navigate through patients with neuro-ophthalmic disorders.

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Quiz

1. Which of the following is generally not considered to be a neuro-ophthalmic urgency or emergency?*

A - Suspected papilledema

B - Giant cell arteritis

C - Intracranial aneurysm

D - Isolated, dilated pupil with no motility deficits

2. Any acute vision loss in the elderly should be immediately suspected as the cause?*

A - Giant cell arteritis

B - Intracranial aneurysm

C - Carotid dissection

D - Pituitary apoplexy

3. Over which age is giant cell arteritis and arteritis ischemic optic neuropathy a consideration?*

A - 30 years

B - 40 years

C - 50 years

D - 70 years

4. Which of the following is typically not elevated in giant cell arteritis?*

A - Erythrocyte sedimentation rate

B - Hemoglobin levels

C - Platelet count

D - C-reactive protein

5. What is the most important definitive treatment for patients with pseudotumor cerebri?*

A - Diamox

B - Weight reduction

C - Topiramate

D - Optic nerve sheath fenestration

6. What is the etiology behind horizontal diplopia in patients with pseudotumor cerebri?*

A - Six nerve palsy

B - Orbital congestion

C - Decompensating phoria

D - Fourth nerve palsy

7. Which of the following is not a typical cause of pseudotumor cerebri?*

A - Venous sinus thrombosis

B - Tetracycline use

C - Meningitis

D - Vitamin A use

8. What is the minimum recommended weight loss for managing pseudotumor cerebri?*

A - Flat 20 lbs.

B - 5% of body weight

C - 10% of body weight

D - 20% of body weight

9. Which of the following regarding an isolated cranial nerve 3 palsy is considered an emergency?*

A - Isolated dilated pupil

B - Complete palsy with pupil sparing

C - Partial palsy with pupil sparing

D - Pupil involved palsy

10. A patient presenting with sudden onset headache, diplopia, and bitemporal visual field loss should immediately be suspected of having which condition?*

A - Pituitary apoplexy

B - Carotid artery dissection

C - Intracranial aneurysm

D - Horner syndrome

11. What is the recommended treatment for patients with giant cell arteritis?*

A - Systemic steroids

B - Systemic non-steroidal drugs

C - Systemic antibiotics

D - A biologic agent

12. What is the typical visual field defect seen in non-arteritic anterior ischemic optic neuropathy?*

A - Central scotoma

B - Paracentral scotoma

C - Inferior arcuate defect

D - Constricted visual field

13. What is the recommended medical treatment for a patient diagnosed with pseudotumor cerebri?*

A - Twice monthly tocilizumab infusions

B - Acetazolamide 500 mg TID

C - Augmentin 500 mg BID

D - Minocycline 50 mg BID

14. Which of the following is not an alternate therapy for pseudotumor cerebri?*

A - Furosemide

B - Bevacizumab

C - Topiramate

D - Zonisamide

15. Which of the following is characteristic of fulminant IIH?*

A - There are different diagnostic criteria compared to typical IIH

B - Vision loss is rapid and often less than 4 weeks from symptoms

C - Medical therapy is nearly always successful

D - If vision loss occurs, it is very slowly progressive

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

A - 17%

B - 30%

C - 58%

D - 72%

17. What field defect is typical for pituitary apoplexy?*

A - Central scotoma

B - Paracentral scotoma

C - Homonymous

D - Bitemporal

18. What is the most concerning cause of a 3rd order, sudden-onset, painful Horner syndrome?*

A - Lung cancer

B - Multiple sclerosis

C - Cavernous sinus malignancy

D - Carotid artery dissection

19. What is the major concern from carotid dissection?*

A - High risk of stroke

B - High risk of myocardial infarction

C - High risk of blindness

D - High risk of intractable diplopia

20. What is the most common cause of cranial nerve 4 palsy?*

A - Trauma

B - Idiopathic

C - Ischemic

D - CNS lesions

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