28 Questions
What is the common treatment for acute paralytic strabismus due to unilateral sixth nerve palsy?
Botulinum neurotoxin
What is the first step in managing strabismic symptoms?
Prescribing glasses
What is the preferred type of prism for long-term treatment of diplopia?
Ground-in Prism
What is a common short-term treatment for diplopia?
Botulinum neurotoxin
What may be necessary after eye muscle surgery for long-term treatment of strabismus?
Prescribing glasses
What is a potential risk following strabismus surgery?
Ocular ischemia
What is the typical dosage range for Botulinum neurotoxin into a muscle?
2 to 4 units
What is the purpose of monocular occlusion as a short-term treatment for diplopia?
To improve visual acuity
Which cranial nerve innervates the superior rectus, medial rectus, inferior rectus, and inferior oblique muscles?
CN III
What is the most common cause of cranial nerve 3 palsy in adults?
Diabetes
Which type of strabismus is associated with abnormal visual development?
Congenital
What are the symptoms of cranial nerve paralysis?
Double vision, blurry vision, reduced peripheral vision, headaches
Which cranial nerve is responsible for eye movement and pupil constriction?
CN III
What type of strabismus may be associated with head tilt?
Neurological onset
Which condition can cause raised intracranial pressure leading to cranial nerve 3 palsy?
Hydrocephalus
What type of tumors or malformations can cause cranial nerve 3 palsy?
Posterior fossa tumors or malformations
Which cranial nerve palsy can result in ipsilateral pre-ganglionic Horner’s syndrome and contralateral superior oblique palsy?
Cranial nerve 4 palsy
What is the common cause of cranial nerve 6 palsy?
Inflammatory meningitis
Which muscle palsies affect the superior rectus and inferior oblique of the same eye?
Double elevator palsy
What is the purpose of the forced duction test?
To diagnose mechanical restrictions or paretic muscles in eye movement
Which type of neurogenic palsies cause gaze palsies and tonic gaze deviation?
Supranuclear lesions
What does double depressor palsy affect?
Inferior rectus and superior oblique of the same eye
What is the management for infranuclear neurogenic palsies affecting CN III, IV, and VI?
Detailed case history and appropriate medical history
What is the main cause of multiple cranial nerve palsies?
Neoplasms
Which test is used to diagnose mechanical restrictions or paretic muscles in eye movement?
Forced duction test
What is the differential diagnosis for muscle palsies like Duane’s retraction syndrome?
Myasthenia gravis
Which cranial nerve palsy affects the lateral rectus?
Cranial nerve 6 palsy
What is the presentation of cranial nerve 6 palsy?
Lateral diplopia and convergent strabismus
Study Notes
Cranial Nerve Palsies in Children and Young Adults
- Cranial nerve 3, 4, and 6 palsy tests include cover tests, pupil testing, and Hess-Lancaster test.
- Cranial nerve 4 palsy affects the superior oblique and can be caused by congenital abnormal development or head trauma.
- Cranial nerve 4 palsy can result in ipsilateral pre-ganglionic Horner’s syndrome and contralateral superior oblique palsy.
- Cranial nerve 6 palsy affects the lateral rectus and can be caused by trauma, aneurysm, or inflammatory meningitis.
- Cranial nerve 6 palsy presentation includes lateral diplopia and convergent strabismus, with lateral rectus being more susceptible to ischemia.
- Multiple cranial nerve palsies can affect CN 3, 4, 5, 6, or Horner’s syndrome, with neoplasms and inflammation being common causes.
- Other forms of paralysis include muscle palsies like Duane’s retraction syndrome, and differential diagnosis includes myasthenia gravis and thyroid eye disease.
- Double elevator palsy affects the superior rectus and inferior oblique of the same eye, resulting in no elevation in abduction or adduction.
- Forced duction test is used to diagnose mechanical restrictions or paretic muscles in eye movement.
- Double depressor palsy affects the inferior rectus and superior oblique of the same eye, leading to no depression in abduction or adduction, with head tilting down as a compensation.
- Neurogenic palsies are categorized into supranuclear, internuclear, and infranuclear, with supranuclear lesions causing gaze palsies and tonic gaze deviation.
- Infranuclear neurogenic palsies affect CN III, IV, and VI, and the management includes detailed case history and appropriate medical history.
Test your knowledge of cranial nerve palsies in children and young adults with this quiz. Explore topics such as cranial nerve 3, 4, and 6 palsy tests, presentations, causes, and differential diagnoses. Dive into the details of muscle palsies, forced duction tests, and the categorization of neurogenic palsies.
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