Board Certified Ophthalmologist Board Certified Ophthalmologist Neuro-Ophthalmology Questions and Answers 2 — Questions and Answers
Question 1: A 45-year-old patient presents with sudden painless monocular vision loss and a relative afferent pupillary defect. Fundoscopy reveals a swollen optic disc with peripapillary hemorrhages. What is the most likely diagnosis?
- Anterior ischemic optic neuropathy (Correct answer)
- Central retinal artery occlusion
- Optic neuritis
- Papilledema
Correct answer: Anterior ischemic optic neuropathy
Anterior ischemic optic neuropathy presents with sudden painless vision loss, RAPD, and a swollen disc with peripapillary hemorrhages, most commonly in patients over 40.
Question 2: Which cranial nerve palsy is most commonly associated with microvascular ischemia in diabetic patients?
- Third nerve palsy
- Fourth nerve palsy
- Sixth nerve palsy (Correct answer)
- Seventh nerve palsy
Correct answer: Sixth nerve palsy
Sixth cranial nerve palsy is the most common isolated cranial nerve palsy caused by microvascular ischemia, frequently seen in diabetic patients.
Question 3: A patient with multiple sclerosis develops bilateral sequential optic neuritis. MRI of the brain shows periventricular white matter lesions. What visual field defect is most characteristic of optic neuritis?
- Bitemporal hemianopia
- Central scotoma (Correct answer)
- Homonymous hemianopia
- Altitudinal field defect
Correct answer: Central scotoma
Central scotoma is the most common visual field defect in optic neuritis, resulting from inflammation of the central fibers of the optic nerve.
Question 4: A 30-year-old woman presents with transient visual obscurations, bilateral disc edema, and an enlarged blind spot on perimetry. Her BMI is 38. What is the most appropriate initial diagnostic study?
- MRI brain with MR venography (Correct answer)
- Carotid Doppler ultrasound
- Fluorescein angiography
- Electroretinography
Correct answer: MRI brain with MR venography
MRI with MR venography is essential to rule out cerebral venous sinus thrombosis before diagnosing idiopathic intracranial hypertension in a patient with papilledema.
Question 5: A patient presents with a complete third nerve palsy including pupil involvement after minor head trauma. CT angiography reveals a 7 mm aneurysm. What is the most likely location of this aneurysm?
- Posterior communicating artery (Correct answer)
- Anterior communicating artery
- Middle cerebral artery bifurcation
- Basilar tip
Correct answer: Posterior communicating artery
Posterior communicating artery aneurysms are the most common cause of a pupil-involving third nerve palsy due to compression of the parasympathetic fibers on the surface of the nerve.
Question 6: What is the hallmark visual field defect seen in a patient with a lesion at the optic chiasm caused by a pituitary adenoma?
- Homonymous hemianopia
- Bitemporal hemianopia (Correct answer)
- Binasal hemianopia
- Central scotoma
Correct answer: Bitemporal hemianopia
Bitemporal hemianopia results from compression of the crossing nasal retinal fibers at the optic chiasm, classically caused by pituitary adenomas growing superiorly.
Board Certified Ophthalmologist Board Certified Ophthalmologist Neuro-Ophthalmology Questions and Answers 2
A 45-year-old patient presents with sudden painless monocular vision loss and a relative afferent pupillary defect.
Fundoscopy reveals a swollen optic disc with peripapillary hemorrhages.
What is the most likely diagnosis?