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CN 1-2 dz

CNpathies

QuestionAnswer
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