Neuro ophthalmology

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Neuro ophthalmology

  1. 1. Neuro-ophthalmology Review Second Hour Thomas M. Bosley, MD Professor of Ophthalmology King Saud University
  2. 2. Neuro-ophthalmology• Afferent• Efferent • Anatomy• Other • Examination • Diagnoses • Tests
  3. 3. Efferent Neuro-anatomy
  4. 4. Efferent Neuro-anatomy
  5. 5. Efferent Neuro-anatomy
  6. 6. Efferent Skull Anatomy
  7. 7. Efferent Skull Anatomy
  8. 8. Orbit Pathology 192689-6
  9. 9. Orbit Pathology 192689-6
  10. 10. Efferent Examination• Just look at patient• Movements of both eyes in all directions• Smooth pursuit• Saccades
  11. 11. Efferent Examination• Just look at patient Are eyes straight?• Movements of both What are the lid positions? eyes in all directions Are the eyes proptotic?• Smooth pursuit Are there any spontaneous eye movements• Saccades
  12. 12. Efferent Examination Are eyes straight? What are the lid positions? Are the eyes proptotic? Are there any spontaneous eye movements 194568-8
  13. 13. Efferent Examination Are eyes straight? What are the lid positions? Are the eyes proptotic? Are there any spontaneous eye movements 163331-7
  14. 14. Efferent Examination Are eyes straight? What are the lid positions? Are the eyes proptotic? Are there any spontaneous eye movements
  15. 15. Efferent Examination Are eyes straight? What are the lid positions? Are the eyes proptotic? Are there any spontaneous eye movements 194568-8
  16. 16. Efferent Examination• Just look at patient Have the patient move eyes in all directions, not just the• Movements of both direction where you think eyes in all directions there is a problem.• Smooth pursuit Hold lids if necessary (only after looking first without• Saccades holding lids) Examine each eye separately if necessary
  17. 17. Efferent Examination Have the patient move eyes in all directions, not just the direction where you think there is a problem. Hold lids if necessary (only after looking first without holding lids) Examine each eye separately if necessary 260007-2
  18. 18. Efferent Examination Have the patient move eyes in all directions, not just the direction where you think there is a problem. Hold lids if necessary (only after looking first without holding lids) Examine each eye separately if necessary 210439-3
  19. 19. Efferent Examination 210439-3
  20. 20. Efferent Examination 210439-3
  21. 21. 10 yo girl• Born with weakness of the face• Parents noticed unusual eye movements at early age• No family history 154333-4
  22. 22. 154333-4
  23. 23. 10 yo girl• Bilateral Mobius syndrome, R>L• Possible congenital injury to 3rd CN OD 154333-4
  24. 24. Efferent Examination• Just look at patient• Movements of both eyes in all directions• Smooth pursuit The reflex that helps to maintain fixation on an• Saccades object in motion in the visual world while the head is stable Also the reflex that inhibits the vestibulo-ocular reflex
  25. 25. Efferent Examination• Just look at patient• Movements of both eyes in all directions• Smooth pursuit• Saccades The reflex that permits a rapid refixation from one point in the visual field to another.
  26. 26. Efferent • Orbit – Extraocular muscles – Trauma• Anatomy – Mass• Examination • Neuromuscular junction• Diagnoses • Single cranial nerves• Tests • Multiple cranial nerves • Intraparenchymal problem – INO – Gaze palsy
  27. 27. Efferent Diagnoses • Orbit – Extraocular muscles – Trauma – Mass • Neuromuscular junction • Single cranial nerves • Multiple cranial nerves • Intraparenchymal problem – INO – Gaze palsy
  28. 28. Efferent Diagnoses • Orbit – Extraocular muscles – Trauma – Mass • Neuromuscular junction • Single cranial nerves • Multiple cranial nerves • Intraparenchymal problem – INO – Gaze palsy
  29. 29. Efferent Diagnoses • Orbit – Extraocular muscles – Trauma – Mass • Neuromuscular junction • Single cranial nerves • Multiple cranial nerves • Intraparenchymal problem 253324-3 – INO – Gaze palsy
  30. 30. 14 yo boy 253324-3
  31. 31. Efferent Diagnoses • Orbit – Extraocular muscles – Trauma – Mass • Neuromuscular junction • Single cranial nerves • Multiple cranial nerves • Intraparenchymal problem – INO – Gaze palsy
  32. 32. 29 yo man • Left optic nerve sheath meningioma resected in 1988 • Developed progressive ptosis in 1993 with pain, treated as sinusitis and resolved • Syndrome recurred in 9/00 067170-3
  33. 33. 29 yo man 067170-3
  34. 34. Efferent Diagnoses • Orbit – Extraocular muscles – Trauma – Mass • Neuromuscular junction • Single cranial nerves • Multiple cranial nerves • Intraparenchymal problem – INO 260007-2 – Gaze palsy
  35. 35. Efferent Diagnoses • Orbit – Extraocular muscles – Trauma – Mass • Neuromuscular junctionOculomotor nerve (3) • Single cranial nervesTrochlear nerve (4) • Multiple cranial nervesAbducens nerve (6) • Intraparenchymal problem – INO – Gaze palsy
  36. 36. Efferent DiagnosesOculomotor nerve (3)Trochlear nerve (4)Abducens nerve (6)
  37. 37. Oculomotor CN Palsy (Note elevation of left lid on gaze down and right – aberrant regeneration of the levator muscle.)
  38. 38. Efferent DiagnosesOculomotor nerve (3)Trochlear nerve (4)Abducens nerve (6)
  39. 39. Efferent DiagnosesOculomotor nerve (3)Trochlear nerve (4)Abducens nerve (6)
  40. 40. Efferent DiagnosesOculomotor nerve (3)Trochlear nerve (4)Abducens nerve (6)
  41. 41. Efferent DiagnosesOculomotor nerve (3)Trochlear nerve (4)Abducens nerve (6)
  42. 42. Efferent Diagnoses • Orbit – Extraocular muscles – Trauma – Mass • Neuromuscular junction • Single cranial nerves • Multiple cranial nerves • Intraparenchymal problem – INO – Gaze palsy
  43. 43. Efferent Diagnoses • Orbit – Extraocular muscles – Trauma – Mass • Neuromuscular junction • Single cranial nerves • Multiple cranial nerves • Intraparenchymal problem – INO – Gaze palsy
  44. 44. Efferent Diagnoses • Orbit – Extraocular muscles – Trauma – Mass • Neuromuscular junction • Single cranial nerves • Multiple cranial nerves • Intraparenchymal problem – INO – Gaze palsy
  45. 45. Efferent Diagnoses • Orbit – Extraocular muscles – Trauma – Mass • Neuromuscular junction • Single cranial nerves • Multiple cranial nerves • Intraparenchymal problem – INO – Gaze palsy
  46. 46. Neuro-ophthalmology Unusual faces• Afferent• Efferent• Other
  47. 47. Neuro-ophthalmology Unusual scans• Afferent• Efferent• Other
  48. 48. Neuro-ophthalmology Unusual teeth• Afferent• Efferent• Other
  49. 49. Neuro-ophthalmology Unusual skin lesions• Afferent• Efferent• Other
  50. 50. Neuro-ophthalmology Unusual postures• Afferent• Efferent• Other
  51. 51. Neuro-ophthalmology• Afferent• Efferent• Other And much, much more …

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