This document provides information on neuro-ophthalmology and the anatomy and pathways related to vision. Some key points:
- The eyes are intimately related to the brain and can provide clues to central nervous system disorders. Cranial nerves III, IV, VI control extraocular muscles, while V and VII are also involved in ocular function.
- The optic nerve has three portions - orbital, intraosseous, and intracranial. It is surrounded by three meningeal sheaths and carries both visual and pupillary fibers from the retina to the brain.
- The visual pathway involves the optic nerve, optic chiasm, optic tract, lateral geniculate body, optic radiation, and
Gede Pardianto - Strabismus, binocular vision, 3D vision and visual illusionGede Pardianto
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Dr. Gede Pardianto.
SMEC Jakarta Jl Pemuda 36 Rawamangun Jakarta Timur.
Sumatera Eye Center Jl Iskandar Muda 278 Medan.
Tel 628155000300.
Gede Pardianto - Strabismus, binocular vision, 3D vision and visual illusionGede Pardianto
Strabismus, binocular vision, 3D vision and visual illusion
Dr. Gede Pardianto.
SMEC Jakarta Jl Pemuda 36 Rawamangun Jakarta Timur.
Sumatera Eye Center Jl Iskandar Muda 278 Medan.
Tel 628155000300.
Optical coherence tomography angiography optovue a very basic lecture detailing the new advancement of dyeless angiography by spectral domain OCT system and SSADA and Motion correction algorithm
It describes about the procedure of Hess charting. it serves as a great tool to understand the concepts involved. Suitable for optometry course. This is not a routine procedure but an important procedure which is used in diagnosis.
Optical coherence tomography angiography optovue a very basic lecture detailing the new advancement of dyeless angiography by spectral domain OCT system and SSADA and Motion correction algorithm
It describes about the procedure of Hess charting. it serves as a great tool to understand the concepts involved. Suitable for optometry course. This is not a routine procedure but an important procedure which is used in diagnosis.
Cranial_Nerves_examination Cranial nerve examination frequently appears in OS...Zachm5
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Diseases of Autonomic Nervous System I Autonomic Nervous System II Nervous Sy...HM Learnings
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This video will cover the following topics:
1. Diseases of Sympathetic Nervous System
2. Horner Syndrome- Pathophysiology, Etiology, Clinical features
3. Raynaud Phenomenon- Pathophysiology, Clinical features
4. Diseases of the Parasympathetic Nervous System
5. Argyll Robertson Pupil- Pathophysiology, Clinical features
6. Adie tonic Pupil- Pathophysiology, Clinical features
You can also watch the same topic on HM Learnings Youtube channel.
You can also follow HM Learnings on facebook, instagram and twitter for daily updates
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
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ASA GUIDELINE
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
2. Neuro-Ophthalmology
• Eyes
– intimately related to the brain
• Give diagnostic clues to CNS disorders
• IC Disease - visual disturbance
CN III, IV, VI – EOM
CN V, VII – also associated with ocular
function
3. Anatomy of the Optic
Nerve
• Trunk consisting of about 1 million axons
arising from the ganglion cells of the
retina
Ganglion Cells axons nerve
fiber layer of the retina OPTIC
NERVE
4. • Portions:
Orbital Portion: 25-30 mm long within the
muscle cone
Intraosseous Portion: 4-9 mm
Intracranial Portion: 10 mm
Diameter: 1.5 mm (within the sclera)
3 mm (within the orbit)
80%: visual fibers
20%: pupillary fibers
Anatomy of the Optic Nerve
6. Sheaths of the Optic Nerve
• PIA
– fibrous tissue with numerous small blood
vessel
– divides the nerve into bundles
– continues to the sclera
Continous with the meninges
7. • ARACHNOID
– from the IC end of optic foramen to sclera
– diaphanous connective tissue membrane
with many septate connections with PIA
Sheaths of the Optic Nerve
Continous with the meninges
8. • DURA
– splits into 2: periorbita (lining the orbital
cavity) and outer dural covering of the optic
nerve
– continous with outer 2/3 of sclera
Sheaths of the Optic Nerve
Continous with the meninges
11. Visual Pathway
• CN II – pathway for special sense of vision
– at the chiasm, more than half of the fibers
decussate; join uncrossed temporal fibers of
the opposite side optic tract
– all impulses from RVF projected to left
cerebrum and vice versa
12. Visual Pathway
• 80% of fibers to lateral geniculate body
and 20% to pretectal area and superior
colliculi
geniculocalcarine tract
optic radiation
occipital cortex
13. Visual Pathway
• Lesions:
– anterior to chiasm – unilateral VF defect
– posterior to chiasm – contralateral
homonymous defect
– chiasmal – bitemporal defect
– more congrous homonomous defect – farther
posterior lesion with macular sparing
(maintenance of good visual acuity)
16. Pupillary Pathways
A. Light Reflex
– Entirely subcortical
– Affrent pupillary fibers within the optic nerve go
to pretectal area of midbrain
Edinger-Westphal nucleus
– Efferent pathway is via CN III to the ciliary
ganglion within the muscle cone
short ciliary nerves sphincter muscle
of the iris
17. Pupillary Pathways
B. Near Reflex
– 3 Reactions:
• Accommodation
• Convergence
• Constriction of the pupil
– Final common pathway – CN III
– Marcus-Gunn Pupil
• Relative Afferent Pupillary Defect (RAPD)
–Swinging flashlight test
21. • Argyll-Robertson Pupil
– Usually bilateral
– <3mm in diameter
– No response to light but responds to neural
stimulus
– Dilate poorly with mydriatics
– Suggestive of: CNS syphillis
23. Clinical Features:
• visual loss is subacute
• impaired color vision and
contrast sensitivity
• pain in the region of the
eye in 90% of cases
• 50% exacerbated by eye
movement
• sluggish pupillary-light
reflex
• central scotoma
• hyperemic optic disc w/
blurring of disc margin
• distension of large veins
24. Treatment
• Steroid therapy
• Methylprednisolone by IV, 1g/day for 3
days
OR
• Oral prednisolone, 1mg/kilo/day tapered
over 10-21 days
25. Optic Disc Edema
• Papilledema/Choked Disk
– non-inflammatory congestion of optic disk
associated with increased ICP (due to
cerebral tumors, abscesses, subdural
hematoma, hydrocephalous, malignant
hypertension)
– Mechanism: obstruction of venous flow
caused by pressure on the Central Retinal
Vein where it leaves the optic nerve
26. Clinical Findings
• enlarged blind spot
• normal VA and
normal VF
• Fundus Findings:
hyperemia of the disk,
blurring of the
margins, distention of
retinal veins, absence
of pulsation of CRV,
disk swelling to 6-10
D, hemorrhages
27. Papilledema
• Takes 24-48 hrs for early papilledema to
occur, 1 wk to develop fully
• Takes 6-8 wks to resolve following
adequate treatment
29. Papilledema
• Can be mimicked by buried drusen of the
optic nerve, small hyperopic disc,
myelinated nerve fibers
30. Course and Prognosis
• May or may not affect vision permanently
• Papilledema of more than 5D, extensive
retinal hemorrhages, macular stars – poor
prognosis
31. Multiple Sclerosis
• Demyelinating disorder of the CNS of
unknown cause, chronic, relapsing, onset
young adult
• Involves the optic nerve, chiasm, brain
stem, cerebellar peduncles, and spinal
cord
• Degeneration of myelin sheaths, glial
tissue overgrowth, and complete nerve
fiber destruction
33. MS
• Retrobulbar/Optic Neuritis
– blurring of vision, central scotoma, dilated
pupil
– diplopia due to EOM involvement from
internuclear ophthalmoplegia
– weakness of one rectus muscle/ptosis
– nystagmus may become permanent (70%)
– VER (visual evoked response) – abnormal in
80% of definite, 43% of probable, and 22% of
suspected cases of MS
34. Anterior Ischemic Optic Neuropathy
• characterized by pallid disc swelling with
acute loss of vision
• due to infarction of the optic nerve from
occlusion or decreased perfusion of the
short posterior ciliary arteries
• occurs in 6th
or 7th
decade of age
• associated with arteriosclerosis
35. Nutritional & Toxic Optic
Neuropathies
• Clinical Features:
– Subacute progressive symmetrical visual loss
w/ central visual field defects
– Poor color vision and temporal disc pallor
36. Nutritional & Toxic Optic
Neuropathies
• Causes:
– Vitamin B Complex deficiency
– Tobacco-Alcohol Amblyopia
– Heavy metal poisoning
– Chemical-induced optic neuropathy
• methanol poisoning (used in photocopier
machines)
– Drug-induced optic neuropathy
• ethambutol, quinine
37. Optic Nerve Trauma
• Indirect Optic Nerve Trauma:
– Optic nerve damage secondary to distant
skull injury
– Occurs in 1% of all head injuries
– Due to transmission of shock waves through
the orbital apex
– Optic nerve avulsion usually results from an
abrupt rotational injury to the globe
38. Optic Nerve Trauma
• Direct Optic Nerve Trauma
– Penetrating orbital trauma
– e.g. fractures involving the optic canal
39. Optic Chiasm
• Lesions of the chiasm cause bitemporal
hemianopsia
• Pituitary gland tumor
40. Internuclear Ophthalmoplegia
• Conjugate horizontal eye movements are
disrupted due to failure of coordination
between the abducens nerve nucleus in
the pons and the oculomotor nucleus in
the midbrain
• Results in slowing of saccades in the
adducting eye producing transient diplopia
on lateral gaze
41. Internuclear Ophthalmoplegia
• Causes
– Multiple sclerosis in young adults
– Brain stem infarction in older patients
– Tumors at arteriovenous malformations
– Encephalitis
42. Syndromes Affecting CN III, IV, VI
• Superior Orbital Fissure Syndrome
– All extraocular peripheral nerves pass through
the superior orbital fissure and can be
involved by trauma or by tumor encroaching
on the fissure
43. Syndromes Affecting CN III, IV, VI
• Orbital Apex Syndrome
• Similar to the superior orbital fissure
syndrome with the addition of optic nerve
signs and greater proptosis and less pain
• Caused by orbital tumor, inflammation,
trauma that damages the optic and
extraocular nerves
44. Syndromes Affecting CN III, IV, VI
• Complete Ophthalmoplegia (Sudden)
– Can be due to brainstem vascular disease,
pituitary apoplexy, myasthenia gravis,
arteriosclerotic basilar aneurysm
45. Myasthenia Gravis
• Abnormal fatigability of striated muscles
after repetitive contraction
• Improves after rest
• Often is first manifested by weakness of
the extraocular muscles
• Diplopia is often an early symptom
46. Chronic Progressive External
Ophthalmoplegia
• Slowly progressive inability to move the
eyes
• Severe early ptosis
• Normal pupillary reactions and
accommodation
• A form of mitochondrial myopathy
48. Electromagnetic SpectrumElectromagnetic Spectrum
• Photons are classified according to their
wavelength
• Longest wavelength: radio and television
waves
• Shortest wavelength: gamma rays
• Middle of the spectrum: visible light
49. Rods and ConesRods and Cones
• Retinal photoreceptors that contain
pigments that preferentially absorb
photons with wavelengths 400-700 nm
• Shortest wavelength: blue and green
• Longer wavelengths: yellow, orange, red
51. 3 Attributes of Color3 Attributes of Color
• Hue
– “color”
– Attribute of color perception denoted by blue,
red, purple, etc
– Depends largely on what the eye and brain
perceive to be the predominant wavelength
present in the incoming light
52. 3 Attributes of Color3 Attributes of Color
• Saturation
– “chroma”
– purity or richness of a color
– When all the light seen by the eye is the same
wavelength, the color is fully saturated
– e.g. pink is a desaturated red
53. 3 Attributes of Color3 Attributes of Color
• Brightness
– Luminance, value
– Quantity of light coming from an object (the
number of photons striking the eye)
55. Relative Luminosity CurvesRelative Luminosity Curves
• Illustrate the eye’s sensitivity to different
wavelengths of light
• Cones’ peak sensitivity: 555 nm
• Rods’ peak sensitivity: 505 nm (blue)
56. TrichromatsTrichromats
• 92% of the population who have “normal”
color vision
• Have all 3 different kinds of cones, normal
concentration of cone pigments, normal
retinal wiring
57. Congenital DichromatismCongenital Dichromatism
• Cones themselves are normal, but one of
the 3 contains the wrong pigment
• Deutranopes:
– Lack green pigment
• Protanopes
– Lack red pigment
• Tritanopes
– Lack blue pigment