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CN 1-2 dz
CNpathies
| Question | Answer |
|---|---|
| where are olfactory receptors located? | nasal cavity |
| what's the tract of CN I? | penetrates cribiform plate of ethmoid bone --> olfactory bulb crossed and uncrossed 2nd order neurons move posteriorly as the olfactory tract |
| where do the CN I fibers go? | frontal and temporal lobes |
| what's the only CN that doesn't go through the thalamus? | I |
| can unilateral lesions of CN I cause anosmia? | if distal to decussation, no |
| what dz cause anosmia? | cold- **most common head trauma neurodegenerative dz other: cystic fibrosis + adrenal insufficiency |
| how does head trauma cause anosmia? | damages fibers over cribiform plate |
| which neurodegenerative dz cause anosmia? | Alzheimer's Parkinson's Huntington's |
| what illness do ppl have ipsilateral anosmia/optic atrophy, contralateral papilledema? | Foster-Kennedy syndrome |
| where/what is the issue with Foster-Kennedy syndrome? | olfactory groove/sphenoid ridge masses -commonly w/ meningiomas |
| why do you get the physical signs of Foster Kennedy syndrome? | pressure on olfactory bulb optic nerve elevated ICP: papilledema |
| how is pseudo foster-Kennedy syndrome different? | unilateral optic atrophy elevated ICP no anosmia due to sequential anterior ischemic optic neuropathy (AION) |
| what are the types of optic neuropathy? | Anterior ischemic optic neuropathy Posterior ischemic optic neuropathy optic neuritis Leber's optic neuropathy |
| how does AION present? | > 50 acute onset minimal pain limited recovery altitudinal defect unilateral optic disc swelling |
| what are the 2 types of AION? how are they different? | non-arteritic: most common, painless, acute, altitudinal arteritic: > 70 yrs age. giant cell arteritis. ass w/ HTN, DM, OSA, HLD |
| what are the char of PION? | ischemia behind optic disc: will not see optic disc swelling |
| when do you see bilateral PION? | sx > 6 hours cardiac & spinal sx pts w/ DM and atherosclerosis |
| what are the char of optic neuritis? | demyelinating inflammatory < 40 subacute onset painful good recovery |
| what are the 4 subtypes of optic neuritis? | retrobulbar neuritis: optic nerve papillitis: optic disc perineuritis: optic nerve sheath (spares nerve) neuroretinitis: swelling of nerve and macula |
| which type of optic neuritis can infection (ex: syphilis) or sarcoid cause? | perineuritis |
| what are the clinical features of optic neuritis? | vision loss eye pain worse w/ movement - 87% loss of color vision- 88% Relative APD- persists in >90% cases |
| describe the vision loss of optic neuritis | gradual: occurs hours to days nadir w/i 1-2 weeks 6-12 mos for nerves to fully heal 2/3 have 20/20 vision when recovered |
| what's the ddx of optic neuritis? | inflamm/autoimmune dz MS NMO syphilis cat scratch dz sarcoidosis lupus |
| do you often see gadolinium enhancement with AION? | no |
| do you often see gadolinium enhancement with optic neuritis? | yes |
| what's the chance of getting MS w/ optic neuritis? | if no other lesions- 25% if lesions in brain- 75% |
| what are the clinical features of NMO? | severe relapsing and progressive demyelinating CNS dz causes optic neuritis + transverse myelitis NMO attacks are more severe w/ less recovery than MS mostly affects women in their 30s more common in non-caucasian women |
| what imaging do you see w/ NMO? | > or = 3 segments of demyelination in spinal cord ( may be up to 15 segments) -can have visible cord expansion in acute phase rare brain lesions, but up to 60% of pts w/ NMO will have non-specific white matter lesions |
| what will CSF in NMO show? | elevated WBC w/ neutrophilic predominance 20-30% have oligoclonal bands +NMO IgG autoantibody (against water channel aquaporin 4) |
| what's the relapse rate for NMO? | highest in 1st year |
| how do you tx acute attacks of NMO? | 1000 mg corticosteroids daily x 5d plasmapheresis for rescue therapy |
| how do you tx chronic NMO? | no standard of care azathioprine (2-3mg/kg/day) + prednisone rituximab |
| which optic neuropathy is inherited? how? | Leber optic neuropathy pt mutation in mitochondrial DNA |
| what's the presentation/pathology in Leber optic neuropathy? | painless vision loss over weeks-months in adolescent males cardiac anomalies: AV conduction pathways (Wolf-Parkinson-White) |
Created by:
Syndenham
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