1. Inconcomitant strabismus refers to a type of heterotropia where the amount of deviation varies in different directions of gaze. Paralytic strabismus is a type of inconcomitant strabismus caused by paralysis of one or more extraocular muscles.
2. Paralysis of the third, fourth, or sixth cranial nerves can cause paralytic strabismus by paralyzing the muscles they innervate. This includes the medial, inferior, and superior rectus muscles (III), the superior oblique muscle (IV), and the lateral rectus muscle (VI).
3. Signs of paralytic strabismus include diplopia, abnormal head posture,
This document provides an overview of neuro-opthalmology, including:
- The anatomy and blood supply of the visual pathway from the optic nerve to the lateral geniculate nucleus.
- Common causes of ischemic optic neuropathy and optic neuritis.
- Localization of different visual field defects based on lesion location.
- Syndromes associated with occipital lobe lesions like Anton syndrome and Balint's syndrome.
- Causes and localization of different types of nystagmus and motility disturbances.
- Pupillary abnormalities and their causes like Horner syndrome and Argyll Robertson pupils.
Diplopia, or double vision, can be caused by ocular misalignment or optical abnormalities. The document discusses various types of diplopia including monocular and binocular diplopia. It describes how to evaluate a patient with diplopia through history, physical exam, and tests to determine the underlying cause which may be supranuclear, nuclear, internuclear, infranuclear, restrictive or orbital issues. Key examination findings that help localize the source of diplopia are discussed.
BRAINSTEM LESION INVOLVING 3rd,4th and 6th cranial nerveShivshankar Badole
This document discusses various brainstem lesions that can cause cranial nerve palsies involving the 3rd, 4th, and 6th nerves. It describes the anatomy and functions of these cranial nerves. It then summarizes several clinical syndromes that can result from lesions in specific brainstem locations, including Weber syndrome, Benedikt's syndrome, internuclear ophthalmoplegia, and Parinaud's syndrome. The localization of lesions and characteristic clinical findings for each syndrome are provided.
Spondylolisthesis is a condition where one vertebra slips out of position over another, usually involving L5 slipping forward over S1. It is caused by problems or defects in the pars interarticularis bone that connects the vertebrae. Spondylolisthesis can be classified based on its underlying cause, including dysplastic, isthmic, degenerative, traumatic, or pathological types. Common symptoms include low back pain and leg pain or numbness that worsens with activity. Diagnosis involves MRI or CT imaging to identify defects in the bone. Treatment options range from conservative measures like bracing or physical therapy for mild cases to spinal fusion surgery for more severe or symptomatic cases.
This document provides an overview of evaluating a patient presenting with diplopia (double vision). It discusses taking a thorough history and performing a physical exam to determine if the diplopia is monocular or binocular. A variety of tests are described to localize the cause and characterize the deviation, such as which muscles are affected and how the diplopia changes with different gazes or head positions. Causes can be supranuclear, nuclear, internuclear, infranuclear or myogenic/restrictive. Imaging may be needed to identify structural lesions.
Duane's retraction syndrome involves congenital miswiring of the medial and lateral rectus muscles, causing limited eye movement. There are typically four types based on the pattern of limited adduction and/or abduction. Treatment may involve glasses, prisms, botulinum toxin injections, or surgery such as recession of the medial or lateral rectus muscles to improve eye alignment and positioning. Brown syndrome similarly involves a congenital or acquired restriction of eye elevation in adduction, believed to be caused by an abnormality of the superior oblique tendon. It is characterized by limited elevation in adduction and downshoot, and may cause a vertical eye misalignment.
This document discusses diplopia (double vision), including its definition, causes, evaluation, and management. It begins by defining diplopia as seeing double due to misalignment of the eyes. The document then discusses the anatomy involved, types of diplopia (monocular vs binocular), approaches to evaluation, common causes like myasthenia gravis and various cranial nerve palsies, methods of examination, and treatment options which can include patching therapy, addressing underlying causes, eye exercises, and in some cases surgery.
This document provides an overview of neuro-opthalmology, including:
- The anatomy and blood supply of the visual pathway from the optic nerve to the lateral geniculate nucleus.
- Common causes of ischemic optic neuropathy and optic neuritis.
- Localization of different visual field defects based on lesion location.
- Syndromes associated with occipital lobe lesions like Anton syndrome and Balint's syndrome.
- Causes and localization of different types of nystagmus and motility disturbances.
- Pupillary abnormalities and their causes like Horner syndrome and Argyll Robertson pupils.
Diplopia, or double vision, can be caused by ocular misalignment or optical abnormalities. The document discusses various types of diplopia including monocular and binocular diplopia. It describes how to evaluate a patient with diplopia through history, physical exam, and tests to determine the underlying cause which may be supranuclear, nuclear, internuclear, infranuclear, restrictive or orbital issues. Key examination findings that help localize the source of diplopia are discussed.
BRAINSTEM LESION INVOLVING 3rd,4th and 6th cranial nerveShivshankar Badole
This document discusses various brainstem lesions that can cause cranial nerve palsies involving the 3rd, 4th, and 6th nerves. It describes the anatomy and functions of these cranial nerves. It then summarizes several clinical syndromes that can result from lesions in specific brainstem locations, including Weber syndrome, Benedikt's syndrome, internuclear ophthalmoplegia, and Parinaud's syndrome. The localization of lesions and characteristic clinical findings for each syndrome are provided.
Spondylolisthesis is a condition where one vertebra slips out of position over another, usually involving L5 slipping forward over S1. It is caused by problems or defects in the pars interarticularis bone that connects the vertebrae. Spondylolisthesis can be classified based on its underlying cause, including dysplastic, isthmic, degenerative, traumatic, or pathological types. Common symptoms include low back pain and leg pain or numbness that worsens with activity. Diagnosis involves MRI or CT imaging to identify defects in the bone. Treatment options range from conservative measures like bracing or physical therapy for mild cases to spinal fusion surgery for more severe or symptomatic cases.
This document provides an overview of evaluating a patient presenting with diplopia (double vision). It discusses taking a thorough history and performing a physical exam to determine if the diplopia is monocular or binocular. A variety of tests are described to localize the cause and characterize the deviation, such as which muscles are affected and how the diplopia changes with different gazes or head positions. Causes can be supranuclear, nuclear, internuclear, infranuclear or myogenic/restrictive. Imaging may be needed to identify structural lesions.
Duane's retraction syndrome involves congenital miswiring of the medial and lateral rectus muscles, causing limited eye movement. There are typically four types based on the pattern of limited adduction and/or abduction. Treatment may involve glasses, prisms, botulinum toxin injections, or surgery such as recession of the medial or lateral rectus muscles to improve eye alignment and positioning. Brown syndrome similarly involves a congenital or acquired restriction of eye elevation in adduction, believed to be caused by an abnormality of the superior oblique tendon. It is characterized by limited elevation in adduction and downshoot, and may cause a vertical eye misalignment.
This document discusses diplopia (double vision), including its definition, causes, evaluation, and management. It begins by defining diplopia as seeing double due to misalignment of the eyes. The document then discusses the anatomy involved, types of diplopia (monocular vs binocular), approaches to evaluation, common causes like myasthenia gravis and various cranial nerve palsies, methods of examination, and treatment options which can include patching therapy, addressing underlying causes, eye exercises, and in some cases surgery.
This document discusses Duane retraction syndrome, an ocular motility disorder characterized by defective horizontal eye movement and narrowing of the eyelid when the eye adducts. It is usually unilateral and sporadic, though some familial cases are due to mutations in the CHN1 gene. There are four types described based on limitations of adduction and abduction. Duane syndrome can occur with other syndromes and limb abnormalities. Clinical features and differential diagnosis are provided. Surgical treatment depends on the type of strabismus and may include recession or resection of extraocular muscles.
This document provides information on the differential diagnosis of vertigo from central nervous system causes. It discusses the pathophysiology, clinical presentation, evaluation, and treatment of various central causes of vertigo including migraine, vertebrobasilar insufficiency, cerebellar and brainstem infarction, cerebello-pontine angle tumors, and multiple sclerosis. The clinical history and physical exam aim to localize the lesion, while imaging, vestibular testing, and occasionally lumbar puncture aid diagnosis. Treatment involves managing the underlying condition, controlling risk factors, and using anti-vertigo medications.
Cranial ns,3,4, 6th, Dr M D Mohire, Kolhapu, MaharashtrarMahavir Mohire
This document discusses cranial nerves III, IV, and VI which control the extraocular muscles and eye movements. It covers the anatomy and pathways of these nerves, common causes of palsies including diabetes, aneurysms and tumors. Specific palsy syndromes are described like internuclear ophthalmoplegia and one involving both CN III and IV. Signs on examination for each nerve palsy are provided along with diagrams to aid localization. Causes of binocular and conjugate gaze palsies are also summarized.
This document discusses various akinetic rigid syndromes including their causes, symptoms, and distinguishing features. The most common etiology is neurodegenerative disorders like Parkinson's disease (PD), multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and diffuse Lewy body disease (DLBD). Idiopathic PD is characterized by rigidity, tremor, bradykinesia, and a generally asymmetric presentation that responds well to levodopa. DLBD can present similarly but has a poorer levodopa response and more early cognitive deficits than PD.
4. Extra ocular movements and strabismus.pptxAnnie Amjad
This document provides an overview of extraocular muscles (EOM), their actions and innervation, as well as types of strabismus. It discusses the six EOM that control eye movement, their primary and secondary actions. It describes different types of eye movement including version, duction, and vergence. It also summarizes various forms of strabismus such as esotropia, exotropia, and convergence insufficiency. The document serves as a comprehensive reference for ophthalmic medical professionals on EOM and strabismus.
4. Extra ocular movements and strabismus.pptxannieamjad1
This document provides an overview of extraocular muscles (EOM), their actions and innervation, as well as types of strabismus. It discusses the six EOM that control eye movement, noting their innervation and actions. Types of eye movement covered include version, duction, and vergence. The document then describes various types of strabismus such as esotropia, exotropia, and convergence insufficiency. In summary, it provides a comprehensive review of EOM function and the classifications of strabismus conditions.
This document discusses Duane syndrome and Brown syndrome, which are congenital cranial dysinnervation disorders (CCDDs) characterized by abnormalities in the development of cranial nerves and muscles. Duane syndrome involves anomalous innervation of the lateral rectus muscle, causing limited eye movement and retraction. It is classified into three types based on the pattern of motility defects. Brown syndrome involves a mechanical restriction of the superior oblique tendon, limiting elevation of the eye in adduction. Both conditions are usually diagnosed based on their characteristic eye movement limitations and may require surgery if causing functional or cosmetic issues.
The document discusses the anatomy and function of the extraocular muscles that control eye movement. It describes the six extraocular muscles - the four rectus muscles and two oblique muscles - and their actions in producing horizontal, vertical and rotational movements. It then discusses different types of strabismus or eye misalignment including congenital esotropia (inward deviation), exotropia (outward deviation), and convergence insufficiency exotropia. Treatment options are provided for different types of strabismus.
This document discusses ectopia lentis, or displacement of the crystalline lens. It begins with an overview of ectopia lentis, including definitions and pathophysiology. Signs and symptoms include visual impairment, fluctuating vision, poor near vision, and visual field defects. Causes of ectopia lentis include trauma, genetic conditions like Marfan syndrome, and other systemic diseases. Evaluation involves assessing vision, external eye exam, imaging, and lab tests if a systemic condition is suspected. Treatment options include refractive correction, surgery like lensectomy, and low vision devices. Low vision management aims to improve distance and near vision through high-power lenses, telescopes, magnifiers and other optical and non-optical aids.
This document provides an overview of topics in applied neurosciences. It discusses the sensory system, special senses including the eye and ear, the motor system, cranial nerves, nerve conduction studies, EEG, neuro-microbiology, and several neurological disorders. Specific signs and symptoms of lesions in different areas of the nervous system are described. Various examination techniques for assessing the sensory and motor systems are also outlined.
The document discusses ocular misalignment known as strabismus or squint. It describes the anatomy of the extraocular muscles and their actions in producing eye movements. It then discusses different types of strabismus including congenital esotropia, accommodative esotropia, exotropia, and paralytic strabismus. Assessment and treatment of strabismus is also covered briefly.
This document provides information about strabismus (squint) including its definition, causes, types, and methods of examination and treatment. It defines strabismus as an ocular deviation resulting from an extraocular muscle imbalance. The main causes discussed are optical obstacles like refractive errors, sensory obstacles like uniocular vision defects, and motor obstacles involving the muscles or nerves. The document describes examining a patient for squint including testing visual acuity, eye movements, the cover-uncover test, and assessing binocular vision. It also discusses heterophoria (latent squint), paralytic squint, and treatment approaches.
This document summarizes various neurogenic conditions that can cause ocular palsies, including fourth nerve (superior oblique) palsy, sixth nerve (lateral rectus) palsy, and third nerve (oculomotor) palsy. It describes the characteristics, causes, examinations, and management for each condition. It also covers syndromes like Duane's retraction syndrome, Brown's syndrome, and dysthyroid eye disease that can restrict eye movement. Systemic conditions like diabetes, hypertension, temporal arteritis, and multiple sclerosis are also noted as potential causes of ocular palsies.
The document discusses various aspects of the cerebellum and cerebellar disorders:
1) The cerebellum is located at the back of the brain below the cerebrum and plays an important role in motor coordination and balance. Damage or dysfunction can cause ataxia, instability, slurred speech, and other issues.
2) There are two main types of cerebellar syndromes - midline syndromes affecting balance and trunk control, and hemispheric syndromes affecting limb coordination.
3) Causes of cerebellar injuries include toxins, autoimmune conditions, structural lesions, and inherited degenerations. Diagnosis involves neurological exams and often MRI scanning.
The document discusses various aspects of the cerebellum and cerebellar disorders:
1) The cerebellum is located at the back of the brain below the cerebrum and plays an important role in motor coordination and balance. Damage or dysfunction can cause ataxia, instability, slurred speech, and other issues.
2) There are two main types of cerebellar syndromes - midline syndromes affecting balance and trunk control, and hemispheric syndromes affecting limb coordination.
3) Causes of cerebellar injuries include toxins, autoimmune conditions, structural lesions, and inherited degenerations. Diagnosis involves neurological exams and often MRI scanning.
The document discusses various aspects of the cerebellum and cerebellar disorders:
1) The cerebellum is located at the back of the brain below the cerebrum and plays an important role in motor coordination and balance. Damage or dysfunction can cause ataxia, instability, slurred speech, and other issues.
2) There are two main types of cerebellar syndromes - midline syndromes affecting balance and trunk control, and hemispheric syndromes affecting limb coordination.
3) Causes of cerebellar injuries include toxins, autoimmune conditions, structural lesions, and inherited degenerations. Diagnosis involves neurological exams and often MRI scanning.
Spondylolisthesis is a condition where one vertebra slips out of position over another, usually involving L5 slipping over S1. It is caused by a defect in the pars interarticularis that causes instability. There are several types including isthmic, degenerative, traumatic, and dysplastic. Isthmic spondylolisthesis is the most common type under age 50 and involves a stress fracture of the pars interarticularis. Degenerative spondylolisthesis is most common over age 50 and does not involve a fracture. Symptoms include low back pain and leg pain or numbness. Treatment depends on severity but may include rest, bracing, physical therapy, or surgery.
This document provides an overview of optic atrophy, including:
1. It defines optic atrophy as degeneration of the optic nerve due to damage to the visual pathways from the retina to the lateral geniculate body.
2. It classifies optic atrophy based on whether damage originates in the retina or more centrally, and by cause. Primary optic atrophy occurs without swelling, while secondary involves prior swelling.
3. Causes of primary optic atrophy include optic neuritis, compression, hereditary conditions, toxins, trauma, and multiple sclerosis. Secondary optic atrophy follows conditions like papilledema.
4. Treatment focuses on the underlying cause, with vitamins sometimes used
This document summarizes the anatomy of the thoracic and lumbar spine. It describes the typical structures of the 5 lumbar vertebrae and discs, as well as the lordosis and exiting nerve roots. It also outlines the anatomy of a typical lumbar vertebra, including the body, vertebral foramen, intervertebral foramen, and ligaments. Additionally, it discusses the spinal cord, nerve roots, conus medullaris, and cauda equina as they relate to the lumbar spine.
This document provides information on examining a case of strabismus. It begins with the author's disclosure statement and then is divided into sections on history, examination, equipment, motor status, sensory status, measurement of deviation, and special tests. The history section covers items like visual acuity, eye involvement, and medical history. Examination assesses areas such as head posture, ocular deviation, eye movements, and binocular vision status. Various tests and equipment used are also outlined.
Eye injuries are common in workplaces, with over 2,000 occurring daily and 10-20% resulting in temporary or permanent vision loss. Proper eye protection could prevent around 90% of injuries. There are three ways to prevent eye injuries - assessing hazards, eliminating hazards through measures like machine guarding, and using appropriate eye protection such as laminated, heat-toughened, or chemically-toughened safety lenses made of materials like glass, CR-39 plastic, or impact-resistant polycarbonate.
This document discusses common eye diseases, their distribution and determinants, and risk factors. It outlines the most common eye problems like refractive errors, age-related macular degeneration, cataract, diabetic retinopathy, and glaucoma. It also discusses how the distribution of eye diseases can change over time, place, or person depending on factors like age, race, education, and behaviors. Finally, it identifies major risk factors for eye diseases, such as increasing age, diabetes, high blood pressure, family history of eye problems, and some risks for children.
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Similar to inconcomitantstrabismus-190128145656.pdf
This document discusses Duane retraction syndrome, an ocular motility disorder characterized by defective horizontal eye movement and narrowing of the eyelid when the eye adducts. It is usually unilateral and sporadic, though some familial cases are due to mutations in the CHN1 gene. There are four types described based on limitations of adduction and abduction. Duane syndrome can occur with other syndromes and limb abnormalities. Clinical features and differential diagnosis are provided. Surgical treatment depends on the type of strabismus and may include recession or resection of extraocular muscles.
This document provides information on the differential diagnosis of vertigo from central nervous system causes. It discusses the pathophysiology, clinical presentation, evaluation, and treatment of various central causes of vertigo including migraine, vertebrobasilar insufficiency, cerebellar and brainstem infarction, cerebello-pontine angle tumors, and multiple sclerosis. The clinical history and physical exam aim to localize the lesion, while imaging, vestibular testing, and occasionally lumbar puncture aid diagnosis. Treatment involves managing the underlying condition, controlling risk factors, and using anti-vertigo medications.
Cranial ns,3,4, 6th, Dr M D Mohire, Kolhapu, MaharashtrarMahavir Mohire
This document discusses cranial nerves III, IV, and VI which control the extraocular muscles and eye movements. It covers the anatomy and pathways of these nerves, common causes of palsies including diabetes, aneurysms and tumors. Specific palsy syndromes are described like internuclear ophthalmoplegia and one involving both CN III and IV. Signs on examination for each nerve palsy are provided along with diagrams to aid localization. Causes of binocular and conjugate gaze palsies are also summarized.
This document discusses various akinetic rigid syndromes including their causes, symptoms, and distinguishing features. The most common etiology is neurodegenerative disorders like Parkinson's disease (PD), multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and diffuse Lewy body disease (DLBD). Idiopathic PD is characterized by rigidity, tremor, bradykinesia, and a generally asymmetric presentation that responds well to levodopa. DLBD can present similarly but has a poorer levodopa response and more early cognitive deficits than PD.
4. Extra ocular movements and strabismus.pptxAnnie Amjad
This document provides an overview of extraocular muscles (EOM), their actions and innervation, as well as types of strabismus. It discusses the six EOM that control eye movement, their primary and secondary actions. It describes different types of eye movement including version, duction, and vergence. It also summarizes various forms of strabismus such as esotropia, exotropia, and convergence insufficiency. The document serves as a comprehensive reference for ophthalmic medical professionals on EOM and strabismus.
4. Extra ocular movements and strabismus.pptxannieamjad1
This document provides an overview of extraocular muscles (EOM), their actions and innervation, as well as types of strabismus. It discusses the six EOM that control eye movement, noting their innervation and actions. Types of eye movement covered include version, duction, and vergence. The document then describes various types of strabismus such as esotropia, exotropia, and convergence insufficiency. In summary, it provides a comprehensive review of EOM function and the classifications of strabismus conditions.
This document discusses Duane syndrome and Brown syndrome, which are congenital cranial dysinnervation disorders (CCDDs) characterized by abnormalities in the development of cranial nerves and muscles. Duane syndrome involves anomalous innervation of the lateral rectus muscle, causing limited eye movement and retraction. It is classified into three types based on the pattern of motility defects. Brown syndrome involves a mechanical restriction of the superior oblique tendon, limiting elevation of the eye in adduction. Both conditions are usually diagnosed based on their characteristic eye movement limitations and may require surgery if causing functional or cosmetic issues.
The document discusses the anatomy and function of the extraocular muscles that control eye movement. It describes the six extraocular muscles - the four rectus muscles and two oblique muscles - and their actions in producing horizontal, vertical and rotational movements. It then discusses different types of strabismus or eye misalignment including congenital esotropia (inward deviation), exotropia (outward deviation), and convergence insufficiency exotropia. Treatment options are provided for different types of strabismus.
This document discusses ectopia lentis, or displacement of the crystalline lens. It begins with an overview of ectopia lentis, including definitions and pathophysiology. Signs and symptoms include visual impairment, fluctuating vision, poor near vision, and visual field defects. Causes of ectopia lentis include trauma, genetic conditions like Marfan syndrome, and other systemic diseases. Evaluation involves assessing vision, external eye exam, imaging, and lab tests if a systemic condition is suspected. Treatment options include refractive correction, surgery like lensectomy, and low vision devices. Low vision management aims to improve distance and near vision through high-power lenses, telescopes, magnifiers and other optical and non-optical aids.
This document provides an overview of topics in applied neurosciences. It discusses the sensory system, special senses including the eye and ear, the motor system, cranial nerves, nerve conduction studies, EEG, neuro-microbiology, and several neurological disorders. Specific signs and symptoms of lesions in different areas of the nervous system are described. Various examination techniques for assessing the sensory and motor systems are also outlined.
The document discusses ocular misalignment known as strabismus or squint. It describes the anatomy of the extraocular muscles and their actions in producing eye movements. It then discusses different types of strabismus including congenital esotropia, accommodative esotropia, exotropia, and paralytic strabismus. Assessment and treatment of strabismus is also covered briefly.
This document provides information about strabismus (squint) including its definition, causes, types, and methods of examination and treatment. It defines strabismus as an ocular deviation resulting from an extraocular muscle imbalance. The main causes discussed are optical obstacles like refractive errors, sensory obstacles like uniocular vision defects, and motor obstacles involving the muscles or nerves. The document describes examining a patient for squint including testing visual acuity, eye movements, the cover-uncover test, and assessing binocular vision. It also discusses heterophoria (latent squint), paralytic squint, and treatment approaches.
This document summarizes various neurogenic conditions that can cause ocular palsies, including fourth nerve (superior oblique) palsy, sixth nerve (lateral rectus) palsy, and third nerve (oculomotor) palsy. It describes the characteristics, causes, examinations, and management for each condition. It also covers syndromes like Duane's retraction syndrome, Brown's syndrome, and dysthyroid eye disease that can restrict eye movement. Systemic conditions like diabetes, hypertension, temporal arteritis, and multiple sclerosis are also noted as potential causes of ocular palsies.
The document discusses various aspects of the cerebellum and cerebellar disorders:
1) The cerebellum is located at the back of the brain below the cerebrum and plays an important role in motor coordination and balance. Damage or dysfunction can cause ataxia, instability, slurred speech, and other issues.
2) There are two main types of cerebellar syndromes - midline syndromes affecting balance and trunk control, and hemispheric syndromes affecting limb coordination.
3) Causes of cerebellar injuries include toxins, autoimmune conditions, structural lesions, and inherited degenerations. Diagnosis involves neurological exams and often MRI scanning.
The document discusses various aspects of the cerebellum and cerebellar disorders:
1) The cerebellum is located at the back of the brain below the cerebrum and plays an important role in motor coordination and balance. Damage or dysfunction can cause ataxia, instability, slurred speech, and other issues.
2) There are two main types of cerebellar syndromes - midline syndromes affecting balance and trunk control, and hemispheric syndromes affecting limb coordination.
3) Causes of cerebellar injuries include toxins, autoimmune conditions, structural lesions, and inherited degenerations. Diagnosis involves neurological exams and often MRI scanning.
The document discusses various aspects of the cerebellum and cerebellar disorders:
1) The cerebellum is located at the back of the brain below the cerebrum and plays an important role in motor coordination and balance. Damage or dysfunction can cause ataxia, instability, slurred speech, and other issues.
2) There are two main types of cerebellar syndromes - midline syndromes affecting balance and trunk control, and hemispheric syndromes affecting limb coordination.
3) Causes of cerebellar injuries include toxins, autoimmune conditions, structural lesions, and inherited degenerations. Diagnosis involves neurological exams and often MRI scanning.
Spondylolisthesis is a condition where one vertebra slips out of position over another, usually involving L5 slipping over S1. It is caused by a defect in the pars interarticularis that causes instability. There are several types including isthmic, degenerative, traumatic, and dysplastic. Isthmic spondylolisthesis is the most common type under age 50 and involves a stress fracture of the pars interarticularis. Degenerative spondylolisthesis is most common over age 50 and does not involve a fracture. Symptoms include low back pain and leg pain or numbness. Treatment depends on severity but may include rest, bracing, physical therapy, or surgery.
This document provides an overview of optic atrophy, including:
1. It defines optic atrophy as degeneration of the optic nerve due to damage to the visual pathways from the retina to the lateral geniculate body.
2. It classifies optic atrophy based on whether damage originates in the retina or more centrally, and by cause. Primary optic atrophy occurs without swelling, while secondary involves prior swelling.
3. Causes of primary optic atrophy include optic neuritis, compression, hereditary conditions, toxins, trauma, and multiple sclerosis. Secondary optic atrophy follows conditions like papilledema.
4. Treatment focuses on the underlying cause, with vitamins sometimes used
This document summarizes the anatomy of the thoracic and lumbar spine. It describes the typical structures of the 5 lumbar vertebrae and discs, as well as the lordosis and exiting nerve roots. It also outlines the anatomy of a typical lumbar vertebra, including the body, vertebral foramen, intervertebral foramen, and ligaments. Additionally, it discusses the spinal cord, nerve roots, conus medullaris, and cauda equina as they relate to the lumbar spine.
This document provides information on examining a case of strabismus. It begins with the author's disclosure statement and then is divided into sections on history, examination, equipment, motor status, sensory status, measurement of deviation, and special tests. The history section covers items like visual acuity, eye involvement, and medical history. Examination assesses areas such as head posture, ocular deviation, eye movements, and binocular vision status. Various tests and equipment used are also outlined.
Similar to inconcomitantstrabismus-190128145656.pdf (20)
Eye injuries are common in workplaces, with over 2,000 occurring daily and 10-20% resulting in temporary or permanent vision loss. Proper eye protection could prevent around 90% of injuries. There are three ways to prevent eye injuries - assessing hazards, eliminating hazards through measures like machine guarding, and using appropriate eye protection such as laminated, heat-toughened, or chemically-toughened safety lenses made of materials like glass, CR-39 plastic, or impact-resistant polycarbonate.
This document discusses common eye diseases, their distribution and determinants, and risk factors. It outlines the most common eye problems like refractive errors, age-related macular degeneration, cataract, diabetic retinopathy, and glaucoma. It also discusses how the distribution of eye diseases can change over time, place, or person depending on factors like age, race, education, and behaviors. Finally, it identifies major risk factors for eye diseases, such as increasing age, diabetes, high blood pressure, family history of eye problems, and some risks for children.
This document discusses disability peoples organizations (DPOs) and the importance of referring patients to relevant DPOs after receiving a diagnosis. It notes that since 1981, people with disabilities have organized DPOs that are majority controlled by people with disabilities. DPOs play an important role in advocating for the rights and needs of people with disabilities. The document outlines different types of DPOs and provides recommendations for eye health services to improve awareness of DPOs and establish clear referral pathways to connect patients with appropriate support services.
The document provides guidance on proper frame selection. It discusses important considerations for frame selection such as facial shape and size, prescription needs, and frame fit. Key factors in frame selection include choosing a shape that complements the wearer's face, ensuring proper nose pad contact and temple fit, and selecting a frame that can adequately hold the necessary prescription lenses. Proper frame selection is important for functional vision, comfort, and aesthetic appearance.
Binocular single vision allows for the blending of separate images from each eye into a composite image. It requires overlapping visual fields between the eyes, intact neural pathways, and corresponding retinal areas. The advantages of binocular vision include wider field of view, better detection of faint images, stereopsis for depth perception, and improved visual acuity. Abnormal retinal correspondence can allow limited binocular vision by pairing the fovea of one eye with a non-foveal point in the other eye.
A frame holds eyeglass lenses in position. Frames come in various styles, sizes, materials and prices. Common parts include the front, eye wires, bridge, end pieces, hinges and temples. Popular materials are plastic, metal and composites. Plastics include cellulose acetate and polycarbonate. Metals include monel and titanium alloys. Composites combine advantages of plastic and metal.
The document discusses the Jackson cross cylinder (JCC) test, which is used to measure accommodation and determine presbyopia. The JCC is a lens made of crossed cylinders that is designed to flip axes when rotated 180 degrees. It is used in tests to determine a patient's cylindrical axis and power. For presbyopia testing, the JCC is placed before each eye while the patient views a cross target at 40 cm. For an accommodative test, the JCC is placed before the eye viewing a target moved closer until lines parallel to one axis appear less clear, indicating the patient's accommodation. The test helps diagnose and measure presbyopia and remaining accommodation.
This document discusses various methods for measuring intraocular pressure (IOP), including direct and indirect techniques. It describes manometry and tonometry in detail. For tonometry, it covers indentation tonometry using the Schiotz tonometer, various types of applanation tonometry including Goldmann, Perkins, pneumatic, and non-contact tonometers. It discusses the principles, techniques, advantages, limitations and sources of error for different tonometry methods. Newer tonometers like dynamic contour and ocular response analyzer are also summarized.
This document outlines Pakistan's National Health Program called "Health for All". It defines primary health care and aims to provide universal health coverage through an essential package of services. The overall goal is to improve the health status of Pakistan's people by enhancing access to services, reducing disease burdens, and protecting the poor from health costs. It also discusses key challenges for Pakistan's health sector such as improving access to care, addressing non-communicable diseases, and developing the pharmaceutical sector.
This document discusses various concepts related to determining reference points, measuring for lenses, and selecting blank sizes. It covers positioning frames properly, centering single vision lenses, calculating prism effects, measuring multifocal segment heights, determining pantoscopic tilt, and finding the minimum blank size based on factors like effective diameter and decentration. Proper frame fitting and reference point placement are essential for accurate lens measurements and specifications.
The study aimed to determine the prevalence, causes, and risk factors of bilateral visual impairment in rural areas of Tianjin, China. A population-based cross-sectional study examined over 12,000 participants and found that the age-standardized prevalence of bilateral visual impairment was 1.86%, low vision was 1.76%, and blindness was 0.11%. The most common causes were cataract, refractive error, age-related macular degeneration, diabetic retinopathy, and glaucoma. Risk factors included older age, female gender, and self-reported diabetes. The prevalence of low vision, especially in those over 50, was higher than in previous Chinese studies.
Cycloplegic refraction involves using eye drops to paralyze the focusing muscles of the eye in order to get a more accurate measurement of a person's refractive error without influence from accommodation. It is particularly useful for children, people with hyperopia or esotropia, those with presbyopia symptoms at a young age, and for evaluating candidates for refractive surgery. While the drops cause temporary blurry vision and light sensitivity, they allow the full refractive error to be determined and properly corrected.
The document discusses various post-refraction tests that can be used to verify refractive corrections, including the plus 1.0 blur test, duochrome test, pinhole test, and binocular balancing tests. The plus 1.0 blur test checks for over- or under-correction by adding a +1.00 lens and checking visual acuity. The duochrome test exploits chromatic aberration to check sphere correction. Pinhole testing verifies subjective correction. Binocular balancing tests like modified Humpriss ensure balanced accommodation between eyes.
This document provides information on visual acuity assessment. It discusses the different components assessed, including visual acuity, contrast sensitivity, visual fields, and more. It describes the four types of visual perception and defines visual acuity as the spatial limit of visual discrimination, measured as the minimum resolvable angle. The document outlines the different types of visual acuity that can be measured, such as minimum visible acuity, minimum separable acuity, Vernier acuity, and recognition acuity. It also discusses various visual acuity charts, including Snellen, LogMAR, Landolt rings, and preferential looking tests that can be used with infants and young children.
Anisometropia is a condition where the two eyes have unequal refractive power, causing blurred vision. It occurs when one eye is nearsighted, farsighted, or a combination of both, with at least a 2 diopter difference between the eyes. While most people have some refractive difference, anisometropia is significant enough to interfere with binocular vision. It can be present at birth or develop later in life, affecting around 6% of children. Treatment depends on severity but may include corrective lenses, contact lenses, or surgery to address issues like amblyopia and prevent dependence on one eye.
High myopia, or severe nearsightedness, is defined as a refractive error of -6.00 diopters or worse. It can be caused by genetic factors and environmental factors like extensive near work. Complications of high myopia include retinal detachment, glaucoma, cataracts, and pathological changes to the eye. Management options include spectacle correction, contact lenses, refractive surgery, and orthokeratology, which uses special contact lenses worn overnight to temporarily reshape the cornea and improve uncorrected vision during the day.
The document describes how a lensmeter works to measure the optical power of lenses. A lensmeter uses a telescopic optical system aligned with a standard lens and illuminated target. It measures the focal length of a test lens and converts it to diopters that are displayed on a rotating drum scale. Key parts of the lensmeter include the eyepiece, lens holder, reticle, target, power drum, and other controls. The document provides steps for using a lensmeter to measure spherical lenses, cylinders including axis, and determining add powers in bifocals.
The document provides guidance on properly selecting eyeglass frames. It discusses important considerations for frame selection including fitting the frame to the wearer's face shape, prescription needs, and lifestyle. Key factors discussed are proper sizing, positioning, and adjustments to ensure a comfortable and flattering fit. Guidance is given for different facial features, prescriptions, ages, and safety needs to help opticians fit patients with the optimal frame.
Bifocals are lenses with two optical powers, one for distance and one for near. There are several types of bifocal segments including round, flat top, curve top, ribbon, and Franklin style. Bifocals can be made through fused, one-piece, or cemented constructions. When measuring for bifocals, the frame is positioned as it will be worn and the bifocal height is measured from the lower limbus or lid margin using a vertical ruler. This ensures the bifocal segment will be at the proper height for the wearer.
This document discusses high hyperopia (farsightedness), including its causes, classification, and potential consequences if left untreated. Hyperopia can be classified based on structure (correlational vs component), degree of refractive error (low, moderate, high), and whether it can be corrected with accommodation (facultative vs absolute). High hyperopia over 5.0 diopters that remains untreated can lead to strabismus and amblyopia. Treatment options include spectacle lenses, contact lenses, and refractive surgery.
Temple of Asclepius in Thrace. Excavation resultsKrassimira Luka
The temple and the sanctuary around were dedicated to Asklepios Zmidrenus. This name has been known since 1875 when an inscription dedicated to him was discovered in Rome. The inscription is dated in 227 AD and was left by soldiers originating from the city of Philippopolis (modern Plovdiv).
Philippine Edukasyong Pantahanan at Pangkabuhayan (EPP) CurriculumMJDuyan
(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 𝟏)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐄𝐏𝐏 𝐂𝐮𝐫𝐫𝐢𝐜𝐮𝐥𝐮𝐦 𝐢𝐧 𝐭𝐡𝐞 𝐏𝐡𝐢𝐥𝐢𝐩𝐩𝐢𝐧𝐞𝐬:
- Understand the goals and objectives of the Edukasyong Pantahanan at Pangkabuhayan (EPP) curriculum, recognizing its importance in fostering practical life skills and values among students. Students will also be able to identify the key components and subjects covered, such as agriculture, home economics, industrial arts, and information and communication technology.
𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐍𝐚𝐭𝐮𝐫𝐞 𝐚𝐧𝐝 𝐒𝐜𝐨𝐩𝐞 𝐨𝐟 𝐚𝐧 𝐄𝐧𝐭𝐫𝐞𝐩𝐫𝐞𝐧𝐞𝐮𝐫:
-Define entrepreneurship, distinguishing it from general business activities by emphasizing its focus on innovation, risk-taking, and value creation. Students will describe the characteristics and traits of successful entrepreneurs, including their roles and responsibilities, and discuss the broader economic and social impacts of entrepreneurial activities on both local and global scales.
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Custom modules offer the flexibility to extend Odoo's capabilities, address unique requirements, and optimize workflows to align seamlessly with your organization's processes. By leveraging custom modules, businesses can unlock greater efficiency, productivity, and innovation, empowering them to stay competitive in today's dynamic market landscape. In this tutorial, we'll guide you step by step on how to easily download and install modules from the Odoo App Store.
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A business may deal with both sales and purchases occasionally. They buy things from vendors and then sell them to their customers. Such dealings can be confusing at times. Because multiple clients may inquire about the same product at the same time, after purchasing those products, customers must be assigned to them. Odoo has a tool called Reception Report that can be used to complete this assignment. By enabling this, a reception report comes automatically after confirming a receipt, from which we can assign products to orders.
Level 3 NCEA - NZ: A Nation In the Making 1872 - 1900 SML.pptHenry Hollis
The History of NZ 1870-1900.
Making of a Nation.
From the NZ Wars to Liberals,
Richard Seddon, George Grey,
Social Laboratory, New Zealand,
Confiscations, Kotahitanga, Kingitanga, Parliament, Suffrage, Repudiation, Economic Change, Agriculture, Gold Mining, Timber, Flax, Sheep, Dairying,
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إضغ بين إيديكم من أقوى الملازم التي صممتها
ملزمة تشريح الجهاز الهيكلي (نظري 3)
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تتميز هذهِ الملزمة بعِدة مُميزات :
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3- دقة الكتابة والصور عالية جداً جداً جداً
4- هُنالك بعض المعلومات تم توضيحها بشكل تفصيلي جداً (تُعتبر لدى الطالب أو الطالبة بإنها معلومات مُبهمة ومع ذلك تم توضيح هذهِ المعلومات المُبهمة بشكل تفصيلي جداً
5- الملزمة تشرح نفسها ب نفسها بس تكلك تعال اقراني
6- تحتوي الملزمة في اول سلايد على خارطة تتضمن جميع تفرُعات معلومات الجهاز الهيكلي المذكورة في هذهِ الملزمة
واخيراً هذهِ الملزمة حلالٌ عليكم وإتمنى منكم إن تدعولي بالخير والصحة والعافية فقط
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Andreas Schleicher presents PISA 2022 Volume III - Creative Thinking - 18 Jun...EduSkills OECD
Andreas Schleicher, Director of Education and Skills at the OECD presents at the launch of PISA 2022 Volume III - Creative Minds, Creative Schools on 18 June 2024.
2. Types of heterotropias
1. Concomitant
2. Non-concomitant (deviation differ by 10 Pd)
Is a type of Heterotropia In which the amount of deviation
varies in different directions of gaze. Further, amount of
deviation may also vary depending on which eye is fixing.
3. Types of Incomitant deviations
1. Non-paralytic (Special types of Strabismus)
i. vertically incomitant horizontal heterotropias e.g.:
A-, V-, X-, Y- and λ- pattern heterotropias
ii. Special restrictive ocular motility defects: e.g.:
Duane’s Retraction syndrome, Brown’s syndrome,
Grave’s ophthalmopathy, etc.
2. Paralytic (Paralysis of Cranial Nerve/s)
4. Vertically incomitant horizontal
heterotropias
Refers to those horizontal deviations that change in
magnitude with upgaze and downgaze
A pattern Horizontal heterotropia:
Increasing convergence (decreasing divergence) in
upgaze and increasing divergence in downgaze.
Considered significant if deviation differ by 10 Pd
A esotropia- esotropia will increase in upgaze and decrease
in downgaze
A exotropia: exotropia will decrease in upgaze and increase
in downgaze
6. Vertically incomitant horizontal
heterotropias
V pattern Horizontal heterotropia:
Increasing convergence (decreasing divergence) in
downgaze and increasing divergence in upgaze.
Considered significant if deviation differ by 15 Pd
V esotropia- esotropia will increase in downgaze and
decrease in upgaze
V exotropia: exotropia will increase in upgaze and decrease
in downgaze
8. Vertically incomitant horizontal
heterotropias
Y pattern Horizontal heterotropia:
Have exotropia only in upgaze
λ- pattern Horizontal heterotropia:
Exotropia in down gaze only
X- pattern Horizontal heterotropia:
No deviation or a small one in primary position, but a
significant exotropia in upgaze as well as in downgaze
9. Ex: Non-Paralytic
Special Types of Strabismus
Duane Syndrome
(face turn to left)
Brown’s Syndrome LE
(head tilt towards affected side)
10. Muscle Innervation
Each EOM is innervated by a specific cranial nerve
1. medial rectus (MR)—cranial nerve III (Inferior branch)
2. superior rectus (SR)—cranial nerve III (Superior
Branch)
3. inferior rectus (IR)—cranial nerve III (Inferior Branch)
4. inferior oblique (IO)—cranial nerve III (Inferior Brach)
5. lateral rectus (LR)—cranial nerve VI
6. superior oblique (SO)—cranial nerve IV
7. Levator Palpebral Superiosis (LPS) - cranial nerve III
(Superior
Branch)
LR6(SO4)3.
11. Paralytic Deviation
Ocular deviation resulting from complete or
incomplete paralysis of one or more
extraocular muscles.
Complete called as palsy
Incomplete called as paresis
19. General features:
Diplopia
Confusion
Ocular deviation : i . primary
ii . Secondary
Ocular movements
Past pointing
Nausea, vertigo & dizziness
Muscle sequelae :
20. Muscle sequelae :
Changes that take place in EO muscle after
sometime of paralysis or paresis of one or
more EO muscle.
i . Overaction of contralateral synergistic
muscle.
ii . Contracture of direct antagonist
iii . Secondary inhibitional palsy of the
contralateral antagonist muscle.
21. Muscle sequelae following
paresis of EO
Paretic muscle Overaction of
contra. Synergist
Contracture of
direct agonist
Sec.inhibitional
palsyofcontra.
Antagonist
RLR LMR RMR LLR
RMR LLR RLR LMR
RSO LIR RIO LSR
RIO LSR RSO LIR
RSR LIO RIR LSO
RIR LSO RSR LIO
30. Cover test:
Both for distance & near , with & without
abnormal head posture
Presence of any manifest or latent deviation
Type of deviation
Primary versus secondary deviation
Normally fixing eye : for the dominant eye.
35. Different types of test :
Diplopia test
Bielschowsky three step test
Haploscopic test
Field of binocular fixation
Other test : FDT , EMG , EOG , Orbital USG ,
Computerised tomographic scanning.
36.
37.
38. Differential diagnosis in
paralytic squint :
Comitant versus incomitant squint
Congenital versus acquired palsies
Paralytic versus restrictive palsies.
39. Clinical varieties of ocular
palsies :
Isolated ocular muscle paralysis : SO (4TH
nerve palsy) and LR (6TH
nerve palsy).
Paralysis of 3rd
cranial nerve
External ophthalmoplegia
Total opthalmoplegia
Internuclear ophthalmoplegia
41. Differences
Paralytic Strabismus Non-Paralytic Strabismus
Types of Onset Usually sudden, rarely may be
slow or since birth
Usually gradual
Age of Onset Any age During Childhood
H/O Head Trauma Common Uncommon
Hering’s Law Follows (20
> 10
Deviation) May not follow
ARC/ Amblyopia Uncommon Possible / Common
Comitancy In Late Stage Common
Head Posture Abnormal Commonly Normal
Past Pointing Present (Recent onset) Rare
Diplopia Usually present Usually absent
Ocular movements Limited in direction of paralyzed
muscle
Usually full
42. Congenital/ Old Paralysis Recent Onset
(Acquired)
Abnormal Head Posture May persist on covering paretic eye Disappears on covering
paretic eye
Diplopia (??) Rare Always Present
Amblyopia May be present Absent
Facial Asymmetry Common with long standing torticollis Absent
Comitancy Spread of Comitancy Incomitant
Past Pointing Absent Present
Abnormal head posture May persist on covering paretic eye
bcoz of scoliosis and contracture of
neck muscle
Disappear in covering
paretic eye
Force duction test May be positive negative
Abnormal head posture
In old photographs
May be present absent
Onset of symptoms Usually indefinite and intermittent Usually definite and sudden
44. Prevalence Of Nerve Paralysis
Nerve Prevalence
(Variable)
III 11%
IV 30% <
VI 45%
Multiple 14%
Holmes n et al
45. Stages of EOM Paralysis
First Stage
After Onset : Weakness of the paralyzed muscle
Maximum Deviation is in the field of action of Paralyzed
Muscle
Second Stage
Direct Overaction (Contracture) Ipsilateral Antagonist
With time: Overshadow the defective action of affected Muscle
Third Stage
Recovery
Deviation will spread to all fields of gazes – Increase in
Comitancy : Spread of Comitancy
46. Consequences of a EOM Paralysis
1. Contracture of Ipsilateral Antagonist
2. Overaction of Contraleral Synergist (yolk muscle)
3. Inhibition Palsy of Contralateral Antagonist
Ex: LLR Palsy
1. LMR Contracture
2. RMR Overaction
3. RLR Under action
47. Consequences of EOM Paralysis
Ex: LLR Palsy
1. LMR Contract
2. RMR Overaction
3. RLR Under action
49. Oculomotor Nerve Paralysis
(III Cranial Nerve)
III Nerve – Superior Branch – LPS/ SR
- Inferior Brach – MR/IO/ IR
- Intrinsic Muscles (Iris/ Ciliary Body)
Rarely Isolated Muscle Paralysis
50. IIIrd
Cranial Nerve Paralysis
PATHOPHYSIOLOGY
Results from damage to the oculomotor nerve anywhere in its
the nucleus in the dorsal mesencephalon
fascicles in the brainstem parenchyma,
the nerve root in subarachnoid space, or
in the cavernous sinus or
posterior orbit.
Interesting Facts (Involvement of IIIrd Nerve Nucleus)
Damage to the third nerve nucleus results in
an ipsilateral third nerve palsy with contralateral superior rectus under action
and bilateral ptosis.
Damage to the third nerve fascicles results in an ipsilateral third nerve
palsy with contralateral hemiparesis (Weber's syndrome),
51. IIIrd
Cranial Nerve Paralysis
Damage to Course of IIIrd Nerve
Damage at the level subarachnoid space produces
an isolated third nerve palsy.
causes
Cavernous sinus involvement
Rarely isolated IIIrd
Nerve palsy
May include pareses of cranial nerves IV, VI and V-1, and an
ipsilateral Horner's syndrome.
Common Causes
metastatic disease, inflammation, herpes zoster, carotid artery
aneurysm, pituitary adenoma and apoplexy, and sphenoid wing
meningioma.
52. IIIrd
Cranial Nerve Paralysis
Isolated Muscle Involvement :
Rare and often congenital
1. Superior Rectus (SR) : Congenital / Secondary to Trauma
2. Medial Rectus (MR) : Very Rare / Congenital
Synergistic Divergence Phenomenon
Simultaneous abduction of both eyes on attempted gaze in
the field of action of paralyzed MR.
?? Reason ? Overaction /Contracture of both LR
3. Inferior Rectus (IR) : Congenital / Rare
4. Inferior Oblique (IO) :
- Least likely to paralyzed
- Congenital / Blunt Trauma : Orbital floor fracture
53. IIIrd
Cranial Nerve Paralysis
Complete Paralysis : Acquired (total or partial)
Sign & Symptoms
Sudden onset with unilateral/ Bilateral Ptosis
Head Ache , Diplopia ??? (Partial Vs Complete)
The affected eye positions
Exotropic {non-comitant}, Hypotropic
position (down and out).
Limitation
Elevation, depression and adduction.
underaction of the superior, inferior, and medial recti
muscles and inferior oblique muscle
Pupillary involvement : dilated and minimally reactive to
light,
Pupillary sparing
54. Hess chart of right third nerve
palsy
Contraction of right chart and expansion of left
Right chart - underactions of all muscles except lateral rectus and superior oblique
Left chart - overactions of all muscles except medial rectus and inferior oblique
56. Trochlear Nerve (IV) Paralysis
SIGNS AND SYMPTOMS
Sudden onset
complaints of vertical diplopia,
which is especially manifest as the patient tries to
read.
Inability to look down and in.
Torticollis
Head tilt contralateral to the affected superior
oblique muscle.
Chin depressed There is frequently concurrent
hypertension and/or diabetes.
Amount of deviation
Hyper-deviation will increase in contralateral gaze,
reduce in ipsilateral gaze
Increase on ipsilateral head tilt, and decrease on
57. Trochlear Nerve (IV) Paralysis
PATHOPHYSIOLOGY
Damage to fourth cranial nerve nucleus (located in the
dorsal mesencephalon)
give a contralateral fourth nerve palsy
Causes
Trauma , hemorrhage, infarction, trauma, hydrocephalus and
demyelinization.
More likely, associated with palsy of cranial
nerves III (Cavernous sinus involvement)
??? Detection
Blunt Trauma to the head or orbit
can cause damage to the trochlea, resulting in superior
oblique muscle dysfunction.
58. Hess chart of right fourth nerve palsy
No significant difference in chart size
Right chart - underaction of superior oblique and overaction of inferior oblique
Left chart - overaction of inferior rectus and underaction of superior rectus
59. CRANIAL NERVE VI PALSY
(Abducen)
VI Supply – Lateral Rectus muscle
SIGNS AND SYMPTOMS
Sudden onset/ head pain
Present with horizontal uncrossed diplopia which
worsens at distance
An abduction deficit with either an esophoric or
esotropic position
Isolated palsy
Neither visual acuity nor visual field loss.
Normal fundus
Except in a bilateral cranial nerve VI palsy (Papilloedema)
60. CRANIAL NERVE VI PALSY
Abducen
PATHOPHYSIOLOGY
Originate from Pons
Close association with the facial nerve & PPRF
Damage to the sixth nerve at the brain stem
VII (facial) nerve palsy or an internuclear ophthalmoplegia.
Within the cavernous sinus
the sixth nerve is joined by
the oculosympathetic nerves and cranial nerves III, IV and V-1.
Damage
VI palsy and Horner's syndrome
Concurrent CN III and IV palsy.
Causes :
Aneurysm, meningioma, pituitary adenoma, inflammation, or fistula.
ischemic infarction
Diabetes and hypertension;
prime cause of isolated sixth nerve palsy.
61. Hess chart of Left CN VI palsy
Contraction of left chart and expansion of right
Left chart - marked underaction of lateral rectus and mild overaction of medial rectus
Right chart - marked overaction of medial rectus
62. Clinical Evaluation of Paralytic
Strabismus
1. Observation
2. EOM Evaluation
3. Cover Test
4. Measurement of deviation
5. Past Pointing
6. Head tilt Test
7. Diplopia/ Hess Charting
8. Force duction/ Force Generation test
9. Imaging Test (CT/ MRI)
68. Park’s Bielschwsky Head tilt Test
Park’s Procedure
Useful for only Isolated Nerve Palsy
Park’s Diagnostic Scheme
1. Which is the hyper eye in primary gaze?
RE/LE
2. Which horizontal field of gaze (right or left)
does the hyperdeviation increase?
3. Bielchowsky Head-Tilt Test: Toward which
shoulder does the hyperdeviation increase?
75. Hess Screen Chart
Additional infromation:
1. Contraction of ipsilateral antagonist
2. Overaction of contralateral synergist
3. Inhibtion palsy of contralateral antagonist.
Diagnosis
- Smallest field – Affected eye
- Field deviated maximum
towards the centre
- affected muscle