Neuro Oc Dz - Exam 2 questions and
answers rated A+ updated
Lecture 6 - Facial Disorders - correct answer ✔✔Lecture 6 - Facial Disorders
What do we call a bilateral intermittent spasm of the orbicularis oculi - correct answer
✔✔*Blepharospasm*
(Can be unilateral onset mostly idiopathic)
Describe the general characteristics of optic neuritis (age, onset, exam findings) - correct answer
✔✔Age: under 45
Onset: acute monocular vision loss (bilateral in children)
Exam Findings:
- *pain on eye movement*
- *reduced CV*
- *reduced contrast sensitivity*
- *APD* (+)
What systemic diseases can develop blepharospasm - correct answer ✔✔Parkinson's
PSP
,MS
Brainstem CVA
Huntington's
Tourette's syndrome
What drug was able to improve VA in 75% of study participants by increasing resolution of
edema to reduce compartment syndrome in non-arteritic AION patients - correct answer
✔✔Triamcinolone Acetonide intravitreal injections 10-22days after AION
What are the 4 most common causes of a hemifacial spasm - correct answer ✔✔
How do we manage a hemifacial spasm - correct answer ✔✔1. Imaging studies (posterior
fossa/brainstem)
2. Botox (botulinum) injections
3. Tegretol/Balofen
4. Suboccipital Craniotomy (non-asorbable sponges between vascular loop and CN VII)
What is the newest treatment for GCA (+describe the drug) - correct answer ✔✔*Actemra*
*SQ injection*
,*Interleukin-6 receptor antagonist medication*
Up-regulation of IL 6 pathway leads to infiltration of inflammatory cells including multinucleated
giant cells into vascular walls with GCA
*allows patient to get off steroid quicker* —> reduces rates of clinical relapse during steroid
tapering in GCA patients (because we usually treat with pred )
Cons: injections usually have to be done in hospital for elderly patients and only 50% efficacy
Is a NAION treated with steroid? - correct answer ✔✔Yes... but not proven to be effective for all
patients!
Which steroids? —>
1. *Triamcinolone Acetonide* (75% VA inc by reducing edema to dec compartment syndrome)
2. Oral Corticosteroids like *Pred* QD (69% VA inc same reason)
Co-manage with internist and LV consult
How do we manage blepharospasm - correct answer ✔✔Step 1: *Rule out irritation and
neurological condition*
Step 2: Begin *Botox* (botulinum) injections & *manage stress*
- frequent Botox injections play a role in formation of neutralizing antibodies
Step 3: Oral medication (*clonazepam*) or surgery (*orbicularis myectomy*)
, How do we treat Arteritic AION - correct answer ✔✔1. *High dose systemic corticosteroids
STAT* (IV>oral) —> don't taper too quick!
2. *Co-manage* with rheumatologist, neurologist, neuro-eye, PCP
3. *Pts return 1 week post-IV steroid then once monthly with serial CRP/ESR* when stable
What differential of non-arteritc AION should be ruled out if there is a vague history - correct
answer ✔✔*Foster-Kennedy Syndrome*
- large mass of suprasellar/frontal area
- will also present with swollen temporal artery (but usually with the other artery pale) and
vision loss
How can we tell the difference from AION? —> F-K Syndrome has gradual vision loss where as
AION is much more acute!
How do we manage facial myokymia - correct answer ✔✔
Is Bell's Palsy an upper motor neuron or lower motor neuron issue - correct answer ✔✔Bell's
Palsy is a *lower* motor neuron issue
What do we call an intermittent unilateral involuntary facial muscle spasm - correct answer
✔✔*Hemifacial Spasm*
Key here is *unilateral* and involvement of upper and lower facial muscles to differentiate it
from blepharospasm
answers rated A+ updated
Lecture 6 - Facial Disorders - correct answer ✔✔Lecture 6 - Facial Disorders
What do we call a bilateral intermittent spasm of the orbicularis oculi - correct answer
✔✔*Blepharospasm*
(Can be unilateral onset mostly idiopathic)
Describe the general characteristics of optic neuritis (age, onset, exam findings) - correct answer
✔✔Age: under 45
Onset: acute monocular vision loss (bilateral in children)
Exam Findings:
- *pain on eye movement*
- *reduced CV*
- *reduced contrast sensitivity*
- *APD* (+)
What systemic diseases can develop blepharospasm - correct answer ✔✔Parkinson's
PSP
,MS
Brainstem CVA
Huntington's
Tourette's syndrome
What drug was able to improve VA in 75% of study participants by increasing resolution of
edema to reduce compartment syndrome in non-arteritic AION patients - correct answer
✔✔Triamcinolone Acetonide intravitreal injections 10-22days after AION
What are the 4 most common causes of a hemifacial spasm - correct answer ✔✔
How do we manage a hemifacial spasm - correct answer ✔✔1. Imaging studies (posterior
fossa/brainstem)
2. Botox (botulinum) injections
3. Tegretol/Balofen
4. Suboccipital Craniotomy (non-asorbable sponges between vascular loop and CN VII)
What is the newest treatment for GCA (+describe the drug) - correct answer ✔✔*Actemra*
*SQ injection*
,*Interleukin-6 receptor antagonist medication*
Up-regulation of IL 6 pathway leads to infiltration of inflammatory cells including multinucleated
giant cells into vascular walls with GCA
*allows patient to get off steroid quicker* —> reduces rates of clinical relapse during steroid
tapering in GCA patients (because we usually treat with pred )
Cons: injections usually have to be done in hospital for elderly patients and only 50% efficacy
Is a NAION treated with steroid? - correct answer ✔✔Yes... but not proven to be effective for all
patients!
Which steroids? —>
1. *Triamcinolone Acetonide* (75% VA inc by reducing edema to dec compartment syndrome)
2. Oral Corticosteroids like *Pred* QD (69% VA inc same reason)
Co-manage with internist and LV consult
How do we manage blepharospasm - correct answer ✔✔Step 1: *Rule out irritation and
neurological condition*
Step 2: Begin *Botox* (botulinum) injections & *manage stress*
- frequent Botox injections play a role in formation of neutralizing antibodies
Step 3: Oral medication (*clonazepam*) or surgery (*orbicularis myectomy*)
, How do we treat Arteritic AION - correct answer ✔✔1. *High dose systemic corticosteroids
STAT* (IV>oral) —> don't taper too quick!
2. *Co-manage* with rheumatologist, neurologist, neuro-eye, PCP
3. *Pts return 1 week post-IV steroid then once monthly with serial CRP/ESR* when stable
What differential of non-arteritc AION should be ruled out if there is a vague history - correct
answer ✔✔*Foster-Kennedy Syndrome*
- large mass of suprasellar/frontal area
- will also present with swollen temporal artery (but usually with the other artery pale) and
vision loss
How can we tell the difference from AION? —> F-K Syndrome has gradual vision loss where as
AION is much more acute!
How do we manage facial myokymia - correct answer ✔✔
Is Bell's Palsy an upper motor neuron or lower motor neuron issue - correct answer ✔✔Bell's
Palsy is a *lower* motor neuron issue
What do we call an intermittent unilateral involuntary facial muscle spasm - correct answer
✔✔*Hemifacial Spasm*
Key here is *unilateral* and involvement of upper and lower facial muscles to differentiate it
from blepharospasm
