OPHTHALMOPLEGIC MIGRAINE
It is a rare condition which was previously considered as a type of migraine.
Recent studies suggest that is it likely to be an inflammatory cranial neuropathy.
The International Headache Classification has reclassified ophthalmoplegic migraine as a type of neuralgia from its earlier classification as a type of migraine.
It is characterised by transient migraine like headache associated with paresis of oculomotor, trochlear and/or abducens nerves.
To arrive at a diagnosis of ophthalmoplegic migraine, other causes should be ruled out by appropriate investigations (like digital subtraction angiography / magnetic resonance angiography of the brain).
- False about Argyll Robertson Pupil is?
A. Accommodation reflex normal
B. Direct pupillary reflex absent
C. Indirect pupillary reflex normal
D. Visual acuity normal
Correct answer : C. Indirect pupillary reflex normal
ARGYLL ROBERTSON PUPIL (ARP)
It is characterised by bilateral constricted pupils.
Accommodation reflex (near reflex) is normal.
Pupillary reflex (light reflex) – both direct and indirect – are absent.
This feature is known as light – near dissociation.
ARP was first described in neurosyphilis by Douglas Moray Cooper Lamb Argyll Robertson, a Scottish Ophthalmologist.
It is also seen in other conditions like encephalitis, diabetic neuropathy, multiple sclerosis, stroke etc.
Site of lesion:
It occurs due to damage to fibers which travel from the pretectal part of midbrain to the Edinger Westphal nucleus.
The rostral fibers which are responsible for the light reflex are affected.
But the caudal fibers which facilitate the accommodation reflex are not affected.
Hence the light reflex is absent and accommodation reflex is present.
- Which of the following is false regarding intraocular retinoblastoma?
A. 94% cases are sporadic
B. Individuals with sporadic retinoblastoma do not pass their genes to their children
C. Reese Ellsworth classification is used for predicting visual prognosis following radiotherapy
D. Tumour calcification can be detected by an ultrasound scan
Correct answer : B. Individuals with sporadic retinoblastoma do not pass their genes to their children
One third of sporadic cases of retinoblastoma are heritable. The remaining sporadic cases do not pass their genes to their children.
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15. Bitemporal hemianopia is a characteristic feature of?
A. Glaucoma
B. Optic neuritis
C. Pituitary tumour
D. Retinitis pigmentosa
Correct answer : c) Pituitary tumour
Pituitary tumours compress the optic chiasma and cause bitemporal hemianopia.
- Diplopia in superior oblique palsy is?
A. Vertical diplopia on downward gaze
B. Vertical diplopia on upward gaze
C. Horizontal diplopia on inward gaze
D. Horizontal diplopia on outward gaze
Correct answer : A. Vertical diplopia on downward gaze