opthalmoplagia opthalmoparesis. eye movement motor coordination motor pathway cerebellum basal...
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Eye movement Eye movement
MotorMotor coordinationcoordination Motor pathway cerebellum Motor pathway cerebellum basal gangliabasal ganglia vestibular systemvestibular system
Paralysis nystagmusParalysis nystagmus opthalmoparesis opthalmoparesis
eye movement(motor) pathway eye movement(motor) pathway
SupranuclearSupranuclear
brainstem Internuclearbrainstem Internuclear
NuclearNuclear
Craineal nerveCraineal nerve
NMJNMJ
musclemuscle
Conjugate gaza palsyConjugate gaza palsy
Horizontal: cortex &pontineHorizontal: cortex &pontine Unilateral restriction of voluntary gaze to Unilateral restriction of voluntary gaze to
one side .one side . Frontal damage: eye look to the lesion Frontal damage: eye look to the lesion epilepsy: eye look awayepilepsy: eye look away Pontine: abducent n or PPRF…impair look Pontine: abducent n or PPRF…impair look
to site of lesion, look away ,towered to site of lesion, look away ,towered hemiplasiahemiplasia
Vertical gaze palsyVertical gaze palsy
Up –gaze palsy:pretectal lesion with damage to Up –gaze palsy:pretectal lesion with damage to post comissurepost comissure
Pretectal: parinaud syndrom: (paralysis of upward Pretectal: parinaud syndrom: (paralysis of upward gaze,lid retraction,impaired converg,convergence gaze,lid retraction,impaired converg,convergence retraction nystagmus,light near dissosiation)retraction nystagmus,light near dissosiation)
Causes: Causes: tumer,hydrocephalus 3tumer,hydrocephalus 3rdrd v compress on PC, stroke v compress on PC, stroke of thalamic of thalamic &midbrain ,MS,truma,wilson,syphlis ,TB,drug &midbrain ,MS,truma,wilson,syphlis ,TB,drug neuroliptic,barbiturate,tegretol)neuroliptic,barbiturate,tegretol)
Oculogyric crisis:Oculogyric crisis:
DefentionDefention:episodic, spasmodic,conjugate :episodic, spasmodic,conjugate ocular deviation,up wared &lateral. ocular deviation,up wared &lateral. Accompanied with mental changes, may Accompanied with mental changes, may associate with dystonia or other dyskinesiaassociate with dystonia or other dyskinesia
CausesCauses: encephalities lethargica, : encephalities lethargica, degenerative dis eg familial parkison, head degenerative dis eg familial parkison, head truma,neurosyphlis,MS,ataxia truma,neurosyphlis,MS,ataxia telengictasia,drug:neuroleptictelengictasia,drug:neuroleptic
Internuclear pathologyInternuclear pathology
INO:INO: Damage to the MLF between 3&6 Damage to the MLF between 3&6
nerve ,impair transmisstion of impulse to the nerve ,impair transmisstion of impulse to the ipsilateral medial rectusipsilateral medial rectus
Impair ipsilateral adduction, abduction Impair ipsilateral adduction, abduction nystagmusnystagmus
No visual symptoms,other diplopiaNo visual symptoms,other diplopia Nystagmus cause not clear but may Nystagmus cause not clear but may
adaptiveadaptive
The one and half syndromeThe one and half syndrome
Impaired congucate gaze to one side & Impaired congucate gaze to one side & impair adduction to the other sideimpair adduction to the other side
PPRF or abducent nucleus + MLFPPRF or abducent nucleus + MLF
Nuclear ,nerve control Nuclear ,nerve control
Double visionDouble vision Brain stem contain the lower motor control Brain stem contain the lower motor control
of the eye movementof the eye movement 33rdrd supply all except: supply all except: 44thth SO, 6 SO, 6th th LR LR
Nuclear (brain stem)Nuclear (brain stem)
Long tract signs Long tract signs Crossed phenomenaCrossed phenomena
Causes:Causes: Tumor,MS,strokeTumor,MS,stroke
cranial nerve pathologycranial nerve pathology
ocular neuropathy :ocular neuropathy : CompressiveCompressive :localization acoording to :localization acoording to
stationsstations Non compressiveNon compressive: trauma, DM, vasculitis, : trauma, DM, vasculitis,
demyelinating ( miller fisher syndrome), demyelinating ( miller fisher syndrome), infection diphtheria infection diphtheria
Ocular nerves pathwayOcular nerves pathway
3,4,63,4,6thth nerve nerve
subarachnoid spacesubarachnoid space
cavernous sinuscavernous sinus
Superior orbital fissureSuperior orbital fissure orbit orbit
At sub arachnoidAt sub arachnoid
Complete 3Complete 3rdrd n palsy +_ other CN n palsy +_ other CN Causes:Causes: Posterior communicating aneurysm 3Posterior communicating aneurysm 3rdrd,superior ,superior
cerebellur 4cerebellur 4thth nerve nerve Tumor :meningeoma ,shwanomaTumor :meningeoma ,shwanoma TraumaTrauma MeningitisMeningitis SAHSAH Uncal herniationUncal herniation
At cavernous sinusAt cavernous sinus
Painful or painless if medially +_ 4,5,6Painful or painless if medially +_ 4,5,6 + Horner syndrome+ Horner syndrome Causes:Causes: Cavernous sinus thrombosisCavernous sinus thrombosis Dural carotid cavernous sinus fistulaDural carotid cavernous sinus fistula Carotid aneurysm lateral painlessCarotid aneurysm lateral painless Pituitary adenoma, apoplexyPituitary adenoma, apoplexy
At superior orbital fissureAt superior orbital fissure
3 +_,4,5.6 (no horner ,no maxillary nerve)3 +_,4,5.6 (no horner ,no maxillary nerve) Causes:Causes: Tolosa hunt syndromeTolosa hunt syndrome
At the orbitAt the orbit
Optic n visual loss, proptosis, swelling of Optic n visual loss, proptosis, swelling of lid ,chemosislid ,chemosis
Causes:Causes: Trauma ,tumor, cellulitesTrauma ,tumor, cellulites
Imp noteImp note
Many lesion extend from cavernous sinus to Many lesion extend from cavernous sinus to orbital apex and vice visceraorbital apex and vice viscera
Combined 3Combined 3rdrd n & sympathetic denervation n & sympathetic denervation is pathognomonic for cavernous sinus lesionis pathognomonic for cavernous sinus lesion
neuromuscularneuromuscular
Myasthenia graves (flactuation)Myasthenia graves (flactuation) botulismbotulism