becoming a better Clinician
Neuro Exam
last updated: July 22, 2016
Dilated pupil (mydriasis) (blown pupil)
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brain swelling / bleeding that has progressed to compression of CN III (usually from cerebral herniation) - unopposed sympathetic stimulation
Drugs
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drugs will dilate the pupils but they will still react to light
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anticholinergic drugs:
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atropine
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scopolamine
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cyclopentolate
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tropicamide
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alpha1-agonists: phenylephrine.
Oculomotor nerve palsy (3rd cranial nerve)
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parasympathetic nerves are in the superficial parts of the nerve, so tend to be more vulnerable to compressive lesions and spared by vascular lesions (e.g. diabetes mellitus).
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If an acute third nerve palsy is accompanied by pupillary mydriasis an aneurysm arising from the posterior communicating artery must be excluded
Others:
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Holmes-Adie pupil (tonic phase)
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post-traumatic iridocyclitis (e.g. direct facial trauma)
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acute closed-angle glaucoma
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physiologicalanisocoria
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ocular prosthesis – the normal pupil may be relatively constricted due to ambient light.
Constricted pupil (miosis)
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one pupil being more dilated than the other
Fundoscopic Exam
Normal Anatomy
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optic disk
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optic cup
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retinal artery/vein
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macula
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fovea
Pathology
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papilledema: optic disk swelling
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hemorrages
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exudate
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narrow vessels
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edema of the optic disk
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glaucoma
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optic neuritis
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macular degeneration
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cataracts