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51 Mimics of AtrophyText
52 Dissection of the carotid arteryImage
53 3-31b - Papilledema StagesGrading Papilledema: Stage 0 GRADING PAPILLEDEMA GRADING PAPILLEDEMA We grade papilledema in order to tell us how severe it is. The most sensible grading scheme has been provided by Lars Frisén. STAGE 0: This woman had documented increased intracranial pressure of 340 mm water. Very little if any ...Image
54 3-32b - Papilledema StagesGrading Papilledema: Stage 1 Stage 1 = C shaped blurring of the nasal, superior and inferior borders. Usually the temporal margin is normal. Also notice the chorio-retinal folds (arrows) that eminate toward the macula (m)Image
55 3-35a - Papilledema StagesGrading Papilledema: Stage 4 Stage 4 = Complete obliteration of the cup and complete obscuration of at least some vessels on the surface of the disc. There may be small dilated capillaries on the disc that resemble telangiectasia. It is not the NFL infarcts or hemorrhages but the obscuration of the ...Image
56 3-36a - Papilledema StagesGrading Papilledema: Stage 5 Stage 5 = Dome-shaped appearance with all vessels being obscured. (Sometimes called "champagne cork" swelling--because of its dome shape.)Image
57 Notching of the Neuro-retinal RimThe neuro-retinal rim becomes thinner; in particular the rim superotemporally and inferortemporally may develop a notch which is usually superior or inferior and rarely nasal or temporal. These notches are believed to be due to focal ischemic damage to the neuro-retinal rim. Glaucoma with Notching a...Image
58 2-37a - Vascular FeaturesWhen looking at the disc, the central retinal artery and vein should be visible. The central retinal artery is usually slightly narrower than the vein. When the central retinal artery goes though the lamina cribrosa, the artery becomes smaller because of diminution of the muscular layer and loss of ...Image
59 3-34c Papilledema StagesGrading Papilledema: Stage 3 Stage 3 = Elevation of the entire disc with partial obscuration of the retinal vessels at the disc margin. Here the vessels are partly obscured and make the development into stage 3 easier to call.Image
60 4-35 - Cupped Optic NerveAtrophic Glaucoma Atrophic glaucomatous discs show thinning of the neuro-retinal rim, "saucerization" (which is shallow cupping), evidence of peripapillary atrophy, and pallor of the very narrow neuroretinal rim. Notice that there is severe atrophy of the nerve fiber layer.Image
61 3-5b - Myelinated Nerve FibersMyelinated nerve fibers are frequently confused with papilledema. The feathery edge of the myelinated fibers that conceal the disc and vessel should provide the clue. These myelinated nerve fibers make the disc look blurred.Image
62 How to Measure the RAPDThis clip demonstrates the examination technique for measuring the Relative Afferent Pupillary Defect (RAPD). Demonstration of balancing an afferent papillary defect using filters in a patient with a resolving optic neuritis and an afferent papillary defect on the left.Image/MovingImage
63 Vestibular NystagmusDiscussion of vestibular nystagmus. Seen with peripheral disorders and central disorders, and in two varieties: spontaneous and positional. Horizontal jerk with small amplitude.Image/MovingImage
64 Duane's Retraction Syndrome Type 1; Lid retractionExample of patients with Duane's Retraction Syndrome, Type 1. Description of components of Duane's Syndrome: limitation of abduction, variable limitation of adduction, and palpebral fissure narrowing and globe retraction with attempted adduction. Type 1 includes limited or absent abduction with norm...Image/MovingImage
65 Central Retinal Artery OcclusionImage/MovingImage
66 Progressive Supranuclear PalsyExample of patient with progressive supranuclear palsy. Discussion of difference between saccadic movement in supranuclear palsy and nystagmus. Shows saccadic intrusions in forward gaze, pursuit, saccades, and doll's head maneuver.Image/MovingImage
67 Spasmus NutansExample of patient with spasmus nutans. Discussion of characteristics of this disorder, such as dissociated or monocular nystagmus, abnormal head position, and to-and-fro head oscillation. Sometimes an eccentric gaze is seen as well (as in patient). Patient has a monocular horizontal nystagmus in th...Image/MovingImage
68 Bilateral Facial MyokymiaExample of a patient with a brain stem glioma. Shows bilateral facial myokymia.Image/MovingImage
69 Duane's Retraction Syndrome Type 3Example of a patient with Type 3 Duane's Retraction Syndrome, as well as bilateral Duane's Syndrome. Shows limitation of abduction in both eyes and adduction in the left eye. Also shows side-view of globe retraction in abduction.Image/MovingImage
70 Internuclear Ophthalmoplegia (2 examples)Two examples of patients with internuclear ophthalmoplegia. First patient has a right internuclear ophthalmoplegia. Patient had subacute bacterial endocarditis with a bacterial abscess in the brain stem. Ductions and gaze to the right look good, but when gazing to the left, the right eye does not ad...Image/MovingImage
71 Hemifacial SpasmExample of patients with hemifacial spasm. First patient has a sequela of Bell's palsy, and is seen to have mainly clonic movements around the eye, with occasional tonic movements around the mouth. Second patient has a cerebellopontine angle epidurmoid tumor, and is seen to have movements around the...Image/MovingImage
72 Congenital Ocular Motor ApraxiaTwo examples of congenital ocular motor apraxia. Patients have trouble initiating saccades, and compensate with head movement. Discussion of how to distinguish this condition from simply not seeing well.Image/MovingImage
73 Convergence Retraction Nystagmus (Parinaud's Syndrome)Examples of patients with convergence retraction nystagmus. Shows saccadic oscillations in patients looking upwards and following downwards moving targets. Also shows a side-view of the retracting movements of the globes.Image/MovingImage
74 Downbeat NystagmusExample of patients with downbeating jerk nystagmus. Demonstrates how oscillations grow more prominent when the patient gazes down or laterally. Discusses some causes, including Arnold-Chiari malformation, infarction, and demyelination.Image/MovingImage
75 Rotary NystagmusExample of a patient with rotary nystagmus, showing occasional counterclockwise rotary movements of both eyes. Seen more in intrinsic disorders of the brainstem.Image/MovingImage
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