2008-2009 Basic and Clinical Science Course: Section 5: by Lanning B. Kline, MD

By Lanning B. Kline, MD

A patient-centered method of the analysis and therapy of significant neuro-ophthalmic stipulations. concentrating on very important providing signs, this booklet leads the reader during the occasionally sophisticated manifestations of neuro-ophthalmic disorder to anatomic localization of lesions and definitive prognosis. additionally contains an outline of the anatomy of the visible pathway, directions for undertaking the neuro-ophthalmic exam and applicable use of diagnostic imaging reports.

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A patient-centered method of the analysis and therapy of significant neuro-ophthalmic stipulations. concentrating on very important offering symptoms, this e-book leads the reader in the course of the occasionally refined manifestations of neuro-ophthalmic illness to anatomic localization of lesions and definitive prognosis.

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Extra resources for 2008-2009 Basic and Clinical Science Course: Section 5: Neuro-Ophthalmology (Basic and Clinical Science Course 2008-2009)

Example text

Within the canal, the optic nerve is relatively anchored and can easily be injured by shearing forces transmitted from blunt facial trauma. At its intracranial passage, the optic nerve passes under a fold of dura (the falciform ligament) that may impinge on the nerve, especially if it is elevated by lesions arising from the bone of the sphenoid (tuberculum) or the sella. Once it becomes intracranial, the optic nerve no longer has a sheath. The anterior loop of the carotid artery usually lies just below and temporal to the nerve, and the proximal anterior cerebral artery (ACA) passes over the nerve.

More superiorly, the fibers travel posteriorly through the deep white matter of the parietal lobe. The macular (central) fibers course laterally, with the peripheral fibers concentrated more at the superior and inferior aspects of the radiations. Injury to fibers within the radiations produces a homonymous hemianopia: a contralateral visual field defect that respects the vertical midline. If the corresponding fibers from the 2 eyes are together, the field defect is identical in each eye (congruous).

Asterisks indicate the location of cell groups of the paramedian tracts, which project to the flocculus. Key: III = oculomotor nucleus; IV = trochlear nucleus; complex; iC = interstitial nucleus of VI = abducens nucleus; cg = central gray; h = habenular Cajal; mb = mamillary body; MT = mammillothalamic tract; N III = rootlets of the oculomotor nerve; N IV = trochlear nerve; N VI = rootlets of the abducens nerve; N VII = facial nerve; nO = nucleus of Darkschewitsch; NRTP = nucleus reticularis tegmenti pontis; PC = posterior com- missure; ppH = nucleus prepositus hypoglossi; sc = superior tractus retroflexus.

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