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Pupillary Paralysis

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1. Pupillary Paralysis

Pupillary Paralysis Pupillary Paralysis Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Pupillary Paralysis Pupillary Paralysis Aka (...) : Pupillary Paralysis , Ophthalmoplegia Internal From Related Chapters II. Pathophysiology Images III. Signs does not constrict to light or accommodation dilatation IV. Causes Virus or lesion Bilateral third nerve involvement s injury Topical Benztropine (Cogentin) Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Pupillary Paralysis." Click on the image (or right click) to open the source website in a new browser window. Related Studies

2018 FP Notebook

2. Pupillary Paralysis

Pupillary Paralysis Pupillary Paralysis Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Pupillary Paralysis Pupillary Paralysis Aka (...) : Pupillary Paralysis , Ophthalmoplegia Internal From Related Chapters II. Pathophysiology Images III. Signs does not constrict to light or accommodation dilatation IV. Causes Virus or lesion Bilateral third nerve involvement s injury Topical Benztropine (Cogentin) Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Pupillary Paralysis." Click on the image (or right click) to open the source website in a new browser window. Related Studies

2015 FP Notebook

3. Pupillary paralysis after tranquillizer. (PubMed)

Pupillary paralysis after tranquillizer. 5565530 1971 10 26 2008 11 20 0007-1447 3 5773 1971 Aug 26 British medical journal Br Med J Pupillary paralysis after tranquillizer. 530-1 Crawford R R eng Case Reports Journal Article England Br Med J 0372673 0007-1447 0 Benzimidazoles 0 Tranquilizing Agents AIM IM Accommodation, Ocular drug effects Adult Benzimidazoles adverse effects Female Humans Paralysis chemically induced Pupil drug effects Schizophrenia drug therapy Tranquilizing Agents adverse

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1971 British medical journal

4. Pupillary paralysis after tranquilizer. (PubMed)

Pupillary paralysis after tranquilizer. 5569991 1971 11 12 2008 11 20 0007-1447 3 5775 1971 Sep 11 British medical journal Br Med J Pupillary paralysis after tranquilizer. 639 Pearson R R eng Journal Article England Br Med J 0372673 0007-1447 0 Benzimidazoles 0 Parasympatholytics 0 Tranquilizing Agents AIM IM Benzimidazoles therapeutic use Female Humans Paralysis chemically induced Parasympatholytics adverse effects Pupil drug effects Tranquilizing Agents therapeutic use 1971 9 11 1971 9 11 0 1

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1971 British medical journal

5. Botulism

Botulism Botulism - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Botulism Last reviewed: February 2019 Last updated: March 2018 Summary Botulinum toxin ingestion leads to a clinical syndrome characterised by cranial nerve palsies, oculobulbar weakness, and descending, symmetrical flaccid paralysis in the absence of fever. Affected patients do not complain of sensory deficits. The diagnosis of botulism is a clinical (...) of botulinum toxin into the systemic circulation. History and exam presence of risk factors blurred vision and diplopia impaired accommodation ptosis oculobulbar weakness hypoglossal weakness dysarthria dysphagia symmetrical descending flaccid paralysis hypotonia feeding difficulties in infants weakened cry in infants hypothermia urinary retention constipation dry mouth and throat postural hypotension gastrointestinal illness diminished or absent deep tendon reflexes absence of fever respiratory

2018 BMJ Best Practice

6. Assessment of cranial nerve mononeuropathy

of colour plates. Patients with unilateral optic nerve impairment have great difficulty identifying colours between eyes (dyschromatopsia), and this is more affected than visual acuity. Pupillary testing: a relative afferent pupillary defect (RAPD) is the only objective test of optic nerve dysfunction. Selhorst JB, Chen Y. The optic nerve. Semin Neurol. 2009;29:29-35. http://www.ncbi.nlm.nih.gov/pubmed/19214930?tool=bestpractice.com Visual fields testing: a basic visual fields test can be performed (...) and 4 paired subnuclei can be distinguished. The most dorsal subnucleus contains the visceral Edinger-Westphal nucleus and the levator palpebrae nucleus. The Edinger-Westphal nucleus mediates pupillary constriction. Laterally the dorsal, intermediate, and ventral subnuclei provide innervation to the ipsilateral inferior rectus, inferior oblique, and medial rectus, respectively. The third nerve fascicles leave the nucleus and pass ventrally through the red nucleus before exiting just medial

2018 BMJ Best Practice

7. Skull fractures

fragments. See also the corresponding sagittal CT image From the teaching collection of Demetrios Demetriades; used with permission [Citation ends]. History and exam presence of risk factors open fracture palpable discrepancy in bone contour Battle's sign periorbital ecchymosis bloody otorrhoea CSF rhinorrhoea facial paralysis, nystagmus, or paraesthesia evidence of trauma cranial pain or headache nausea altered mental state/loss of consciousness abnormal pupillary reflexes hearing loss male sex fall

2017 BMJ Best Practice

8. CRACKCast E147 – General Approach to the Poisoned Patient

collateral information as possible! Aspects of the physical exam not to overlook (clues toward a specific toxin or toxidrome): Airway! Breathing! Circulation… Full vitals, rectal core temperature, glucose LOC, pupillary size, Seizure activity, clonus, reflexes, muscle tone Skin moisture Odour Finally, just because we’re talking Tox, don’t forget about a comprehensive approach to altered mental status! DIMES Lifeinthefastlane has a great mnemonic: R – R – S – I – D – E – A – D – Note: Most tox icologic (...) is performed in the following way: Intubation Heavy sedation +/- paralysis Place patient in L lateral decubitus Place a 30 Fr or larger orogastric tube Use specialized fenestrated tubes with rounded ends for this purpose Confirm w/ xray Apply suction: If it is a liquid ingestion simply applying suction through an NG is sufficient Otherwise, you should give ~100 -200 cc alloquotes of water down the OG and then aspirate it back until you are no longer getting gastric contents/pill fragments. [10] List 5 D

2018 CandiEM

9. How well do you know your anticholinergic (antimuscarinic) drugs?

as a bat, mad as a hatter , red as a beet, hot as a hare, dry as a bone, the bowel and bladder lose their tone, and the heart runs alone.” This refers to pupillary dila- tion and impaired lens accommodation, delusions, hallucinations or delirium, flushing, hyperthermia, dry mucosae and skin, gastrointestinal and bladder paralysis, and tachycardia. 1 Shorter mnemonics fail to capture the broad range of anticholinergic toxicity shown in Table 3. © Table 1: Anticholinergics in the Top 100 (BC Data, 2016

2018 Therapeutics Letter

10. CRACKCast E103 – Headache Disorders

risk factors Venous stasis Neurosurgical procedures Hypercoagulable state Genetic Antithrombin III, protein C and S deficiencies Factor V leiden mutation Acquired pregnancy Malignancy Exogenous estrogen Vasculitis IBD Connective tissue disease Endothelial injury Head trauma Surgery Parameningeal infections Presentation: Increased ICP due to impaired venous drainage Diffuse, increasing h/a over days-weeks. Seizures Papiledema **Key symptoms: Ocular findings of pain and proptosis and paralysis (...) ) Attributed to ISCHEMIA and SYSTEMIC INFLAMMATION Headache – 70% OF PTS. usually chronic for 2-3 months. Can be anywhwere on the head 40% of pts develop symptoms of PMR Risk for: TIA’s of the eye, peripheral neuropathies, strokes. On exam: Temporal artery: Findings include tenderness, reduced or absent pulsations, erythema, and nodularity or swelling. Visual acuity, visual field testing, and thorough funduscopic examination should be performed. The presence of a relative afferent pupillary defect (Marcus

2017 CandiEM

11. CRACKCast E022 – Red and Painful Eye

of the eye exam: Eight Key Components: VVEEPP + Slit Lamp + Fundoscopy VVEEPP Visual acuity (Vital Sign) Visual field testing External examination Extraocular movements Pupillary evaluation Pressure Determination Slit Lamp Fundoscopy VVEEPP Explained V: Visual acuity (vital sign of the eye): Snellen eye chart at 20 feet or Rosenbaum chart at 14 inches Allen chart for young children and infants If they cannot use the chart: Are they able to read the paper/phone? Counting fingers Perceive hand motion Able (...) the eyes through ALL the cardinal movements of gaze Inquire about diplopia (especially at the extremes of gaze) This may suggest ocular muscle entrapment, or functional edema P: Pupillary evaluation Assess size, shape, reactivity Assess for RAPD using the swinging flashlight test P: Pressure determination Intraocular pressures normally 10-20 mmHg IO HTN Differential Diagnosis: Glaucoma Suprachoroidal hemorrhage Retrobulbar pathology Pressures in the 20-30 range should get ophthalmology follow-up

2017 CandiEM

12. CrackCAST E129 – Bacteria

paralysis. The mortality rate for patients with left bundle branch block and atrioventricular block is 60% to 90%. [2] What are the 3 phases of illness in pertussis? Respiratory illness transmitted by aerosolized droplets. It can occur at any age but is predominantly a pediatric and adolescent illness. Pertussis means “violent cough.” It is also called whooping cough because the severe episodes of coughing are followed by forceful inspiration, which creates a characteristic whooping sound. Pertussis has (...) support. Even with limited resources, mortality can be reduced to less than 50% with basic medication and experienced medical personnel. [7] List 5 differential diagnoses for Bell’s Palsy Common entities: CVA Trigeminal neuralgia Herpes zoster oticus (Ramsay Hunt syndrome) CNS tumour – acoustic neuroma; cerebellopontine angle lesions (meningioma); facial nerve schwanoma, parotid gland tumour, sarcoma Parotitis Malignant otitis externa Uncommon entities Cephalic tetanus Tick paralysis Botulism CN

2017 CandiEM

13. CRACKCast E109 – CNS Infections

] List 6 immediate and 6 delayed complications of bacterial meningitis BOX 99.2 Complications of Bacterial Meningitis IMMEDIATE Coma Loss of airway reflexes Seizures Cerebral edema Vasomotor collapse Disseminated intravascular coagulation (DIC) Respiratory arrest Dehydration Pericardial effusion Death Others DELAYED Seizure disorder Focal paralysis Subdural effusion Hydrocephalus Intellectual deficits Sensorineural hearing loss Ataxia Blindness Bilateral adrenal hemorrhage Death Cerebral venous (...) suggested that a normal CT scan does not always mean that performance of an LP is safe and that certain clinical signs of impending herniation (ie, deteriorating level of consciousness, particularly a Glasgow coma scale <11; brainstem signs including pupillary changes, posturing, or irregular respirations; or a very recent seizure) may be predictive of patients in whom an LP should be delayed.” [12] What are indications for LP in CNS infection? What are contraindications to LP? Indications: Whenever

2017 CandiEM

14. CRACKCast E105 – Brain and Cranial Nerve Disorders

function and pathologic features when injured Cranial Nerve Function of Nerve Presentation CN I: Olfactory N. Gustatory sense Unilateral anosmia CN II: Optic N. Sight Unilateral vision loss CN III: Oculomotor N. Motor function of levator palpebrae, superior rectus, medial rectus, inferior rectus, and inferior oblique muscles; pupillary constriction Ptosis, eye deviated laterally and downward, diplopia, dilated and non-reactive pupil, loss of accommodation CN IV: Trochlear N. Motor function of superior (...) = Carbamazapine 100mg PO BID. Other options: Phenytoin Baclofen Valproate sodium Lamotrigine Gabapentin Levetiracetam Disposition: Neurology with +/- Neurosurgery or ENT consult if surgical decompression is required [4] Facial nerve paralysis: List 6 differential diagnoses for facial (CN VII) paralysis Bell’s palsy Ramsey Hunt syndrome (herpes zoster oticus) Lyme disease (neuroborreliosis) Bacterial infections of the middle ear, mastoid, or external auditory canal Guillain-Barré syndrome HIV infection Tumor

2017 CandiEM

15. Orbits, Vision and Visual Loss

of an anterior-draining CCF or diplopia and pain in the posterior-draining CCFs [20]. Enophthalmos, or posterior displacement of the globe, may be caused by a development condition resulting in an absent globe (anophthalmia) or small globe (microphthalmia) by traumatic injury to the bony orbit, silent sinus syndrome, processes that result in atrophy of the extraocular muscles, or by a desmoplastic neoplastic/inflammatory process [9,21-24]. If the asymmetry is associated with a white pupillary reflex (...) to detect pathology in patients presenting with vision loss. Variant 8: Ophthalmoplegia or diplopia. Initial imaging. Ophthalmoplegia is paralysis of one or more extraocular muscles. This may be caused by impaired motility of the muscles, disrupted nerve conduction along the neuromuscular junction, or from denervation of the affected cranial nerve or brainstem nucleus. Ophthalmoplegia may also be related to granulomatous, inflammatory, neoplastic, and traumatic abnormalities that primarily affect

2017 American College of Radiology

16. Post-Resuscitation Therapy in Adult Advanced Life Support

that multiple modalities of testing (clinical exam, neurophysiological measures, imaging, or blood markers) be used to estimate prognosis instead of relying on single tests or findings. 25. ANZCOR recommends using bilaterally absent pupillary light reflexes (PLRs) or the combined absence of both pupillary and corneal reflexes at least 72 hours after ROSC to predict poor outcome in patients who are comatose after resuscitation from cardiac arrest and who are treated with TTM. 26. ANZCOR suggests against (...) that the presence of status myoclonus during the first 72 hours from ROSC be considered at 72 hours after ROSC (in combination with other factors) as a predictor for prognosticating a poor neurologic outcome. 29. ANZCOR suggests prolonging the observation of clinical signs when interference from residual sedation or paralysis is suspected, so that the possibility of obtaining false- positive results is minimized. We recommend that the earliest time to prognosticate a poor neurologic outcome is 72 hours after

2016 Australian Resuscitation Council

17. Medical Concepts: Acute Angle Closure Glaucoma

the trabecular meshwork into Schlemm’s canal. 2 In acute angle closure glaucoma, the flow to the trabecular meshwork is blocked by contact between the lens and the iris resulting in accumulation of aqueous humor in the posterior chamber. This is referred to as “pupillary block.” 3 As pressure in the posterior chamber rises, the iris is pushed further forward and causes the angle between the peripheral iris, trabecular meshwork, and cornea to close, hence the name acute angle closure glaucoma. With permission (...) . In addition patients may present with blurred vision, frontal headache, nausea and vomiting, photophobia, and colored halos around lights. 4 Nausea and vomiting occurs as a result of autonomic stimulation, while blurred vision and colored haloes are a result of corneal edema. 5 The onset is often precipitated by dilation of the pupil. When the pupil is mid-dilated, the contact between the iris and the lens is maximal and the iris thickens, which worsens pupillary block. 6 Patients often describe onset

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2016 CandiEM

18. Bilateral acute depigmentation of iris: 3-year follow-up of a case (PubMed)

of the patient revealed symmetrical pigment deposition in trabecular meshwork. No iris transillumination defect, pupillary sphincter paralysis, keratic precipitates, and inflammatory reaction in anterior chamber were seen. The depigmented iris stroma became repigmented symmetrically after 3-year follow-up period. Although it is rare, BADI should be considered in the differential diagnosis of the diseases with bilateral iris depigmentation.

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2018 Therapeutic Advances in Ophthalmology

19. Chromatic Pupillometry to Assess the Melanopsin-Light Pathway in Progressive Supranuclear Palsy

: Recruiting First Posted : November 6, 2017 Last Update Posted : November 7, 2017 See Sponsor: Massachusetts General Hospital Collaborators: NeurOptics Inc. University of Toronto Information provided by (Responsible Party): Shirley Wray, Massachusetts General Hospital Study Details Study Description Go to Brief Summary: The specific aim of this study is to investigate rod, cone and melanopsin driven pupillary light response in individuals with progressive supranuclear palsy (PSP), age-matched healthy (...) Proteinopathies Proteostasis Deficiencies Metabolic Diseases Ophthalmoplegia Ocular Motility Disorders Cranial Nerve Diseases Paralysis Neurologic Manifestations Eye Diseases Signs and Symptoms

2017 Clinical Trials

20. A Horned Viper Bite Victim with PRES (PubMed)

A Horned Viper Bite Victim with PRES Neurological complications of snake bites have been well documented in the literature as neuromuscular paralysis and cerebrovascular complications; posterior reversible encephalopathy syndrome was rarely described. A 23-year-old lady presented near full term of her pregnancy with a horned snake Cerastes cerastes bite; after successful delivery she started complaining of altered mental status and visual disturbance with ulceration over the site of the snake (...) bite. On admission, the patient had Glasgow Coma Score of 12, blood pressure 130/80 mmHg, temperature 38°C, sinus tachycardia at 120 beats per minute, severe dehydration, and reduction in visual acuity to "hand motion" in both eyes with poor light projection and sluggish pupillary reactions. CT brain was not conclusive; MRI revealed features of PRES. Treatment was mostly supportive within one week; the patient regained consciousness; visual disturbance, however, persisted. This patient as well

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2017 Case reports in neurological medicine

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