Head presentations

Question 1

What are the most important questions for double vision presentation?

Answer 1

1. Does it disappear when you close 1 eye (all neuro uncoordinated diplopia will disappear. If doesn’t then it may be anxiety or issues with structure of the eye)
2. Is it horizontal or vertical (will exclude some muscular causes)
3. Is it worse when you’re looking closely or in the distance? (will distinguish between the different muscles that could be causing it)
4. Is it particularly bad at any time of day? (be exclude myasthenia gravis if worse at the end of the day)
5. What are the vascular risk factors? (Stroke is the most common cause of 6th nerve palsy)

Question 2

What is the most common nerve palsy that causes double vision?

Answer 2

6th cranial nerve

Question 3

What is Bell’s palsy?

Answer 3

Swelling of the facial nerve (CN7)

Question 4

What are some causes of ptosis?

Answer 4

Tumour behind or around the eye
Diabetes
Horner syndrome
Myasthenia gravis
Stroke
Swelling of the eye

Question 5

What is Horner’s syndrome?

Answer 5

Presents with partial ptosis, miosis (constricted pupil), and facial anhidrosis due to a disruption in the sympathetic nerve supply

Never more than 1mm of ptosis so it’s hard to notice

Question 6

What is carotid artery dissection?

Answer 6

Dissection of the layers of the vessels, causes clots that may lead to stroke

It can be caused by Horner’s syndrome

Question 7

What are the serious causes of 3rd nerve palsy?

Answer 7

Aneurysm of the posterior communicating artery
Pupil will be large if there is pressure on the nerve

So do CT angiogram

Question 8

What makes eye muscles unique?

Answer 8

They are always active so are full of mitochondria, a bit like cardiac muscle

So mitochondrial disease can present with ptosis and heart disease may run in the family

MND spares eyes, but don’t know why