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Neuroophthalmology

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Which of the following is true of Balint syndrome?

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(A) It results from bilateral extensive frontal damage.

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(B) It is characterized by a difficulty initiating slow eye movement.

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(C) It is characterized by the presence of simultagnosia.

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(D) It is usually associated with preservation of visual field.

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(E) Visual guidance pointing is preserved.

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(C) Balint syndrome is an acquired oculomotor apraxia caused by an extensive bilateral parietooccipital lesion. There is a difficulty in initiating reflexive visually guided saccades and pursuit in all directions with intact vestibular eye movements. Other signs of Balint syndrome include simultagnosia (inability to perceive more than one object at a time), optic ataxia (inaccurate visual guided pointing), and ocular motor apraxia (difficulty in initiating voluntary saccades). These symptoms are frequently associated with dementia and visual field defects. (Kline, 68)

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What type of nystagmus is frequently associated with vertigo and tinnitus?

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(A) Downbeat nystagmus

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(B) Seesaw nystagmus

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(C) Spasmus nutans

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(D) Upbeat nystagmus

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(E) Vestibular nystagmus

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(E) Vestibular nystagmus is characterized by a mixed direction, horizontal–torsional primary position nystagmus. It is of maximal amplitude when the gaze is directed toward the fast component. The nystagmus is suppressed by visual fixation and increased when fixation is removed. The fast phase usually beats away from the damaged end organ. The nystagmus is usually associated with tinnitus, vertigo, and deafness. (Kline, 82–85)

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What type of nystagmus is frequently associated with Arnold–Chiari malformation?

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(A) Downbeat nystagmus

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(B) Seesaw nystagmus

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(C) Spasmus nutans

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(D) Upbeat nystagmus

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(E) Vestibular nystagmus

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(A) Downbeat nystagmus is characterized by the occurrence of a fast phase down while the eyes are in primary position. It is usually associated with lesions at the craniocervical junction, such as Arnold–Chiari malformation, and is often accentuated during lateral downgaze. (Kline, 82–85)

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Head turning and head nodding, is usually associated with

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(A) downbeat nystagmus

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(B) seesaw nystagmus

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(C) spasmus nutans

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(D) upbeat nystagmus

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