neuro-ophthalmology review second hour
DESCRIPTION
Neuro-ophthalmology Review Second Hour. Thomas M. Bosley, MD Professor of Ophthalmology King Saud University. Afferent Efferent Other. Anatomy Examination Diagnoses Tests. Neuro-ophthalmology. Efferent Neuro-anatomy. Efferent Neuro-anatomy. Efferent Neuro-anatomy. - PowerPoint PPT PresentationTRANSCRIPT
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Neuro-ophthalmology ReviewSecond Hour
Thomas M. Bosley, MDProfessor of Ophthalmology
King Saud University
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Neuro-ophthalmology
• Afferent• Efferent• Other
• Anatomy• Examination• Diagnoses• Tests
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Efferent Neuro-anatomy
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Efferent Neuro-anatomy
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Efferent Neuro-anatomy
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Efferent Skull Anatomy
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Efferent Skull Anatomy
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Orbit Pathology
192689-6
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Orbit Pathology
192689-6
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Efferent Examination
• Just look at patient• Movements of both
eyes in all directions• Smooth pursuit• Saccades
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Efferent Examination
• Just look at patient• Movements of both
eyes in all directions• Smooth pursuit• Saccades
Are eyes straight?
What are the lid positions?
Are the eyes proptotic?
Are there any spontaneous eye movements
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Efferent Examination
Are eyes straight?
What are the lid positions?
Are the eyes proptotic?
Are there any spontaneous eye movements
194568-8
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Efferent Examination
Are eyes straight?
What are the lid positions?
Are the eyes proptotic?
Are there any spontaneous eye movements
163331-7
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Efferent Examination
Are eyes straight?
What are the lid positions?
Are the eyes proptotic?
Are there any spontaneous eye movements
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Efferent Examination
Are eyes straight?
What are the lid positions?
Are the eyes proptotic?
Are there any spontaneous eye movements
194568-8
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Efferent Examination
• Just look at patient• Movements of both
eyes in all directions• Smooth pursuit• Saccades
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
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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
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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
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Efferent Examination
210439-3
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Efferent Examination
210439-3
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10 yo girl
• Born with weakness of the face
• Parents noticed unusual eye movements at early age
• No family history
154333-4
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154333-4
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10 yo girl
• Bilateral Mobius syndrome, L>R
• Possible congenital injury to 3rd CN OD
154333-4
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Efferent Examination
• Just look at patient• Movements of both
eyes in all directions• Smooth pursuit• Saccades
The reflex that helps to maintain fixation on an object in motion in the visual world while the head is stable
Also the reflex that inhibits the vestibulo-ocular reflex
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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.
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Efferent• Orbit
– Extraocular muscles– Trauma– Mass
• Neuromuscular junction• Single cranial nerves• Multiple cranial nerves• Intraparenchymal
problem– INO– Gaze palsy
• Anatomy• Examination• Diagnoses• Tests
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Efferent Diagnoses• Orbit
– Extraocular muscles– Trauma– Mass
• Neuromuscular junction• Single cranial nerves• Multiple cranial nerves• Intraparenchymal problem
– INO– Gaze palsy
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Efferent Diagnoses• Orbit
– Extraocular muscles– Trauma– Mass
• Neuromuscular junction• Single cranial nerves• Multiple cranial nerves• Intraparenchymal problem
– INO– Gaze palsy
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Efferent Diagnoses• Orbit
– Extraocular muscles– Trauma– Mass
• Neuromuscular junction• Single cranial nerves• Multiple cranial nerves• Intraparenchymal problem
– INO– Gaze palsy
253324-3
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14 yo boy
253324-3
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Efferent Diagnoses• Orbit
– Extraocular muscles– Trauma– Mass
• Neuromuscular junction• Single cranial nerves• Multiple cranial nerves• Intraparenchymal problem
– INO– Gaze palsy
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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
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29 yo man
067170-3
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Efferent Diagnoses• Orbit
– Extraocular muscles– Trauma– Mass
• Neuromuscular junction• Single cranial nerves• Multiple cranial nerves• Intraparenchymal problem
– INO– Gaze palsy
260007-2
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Efferent Diagnoses• Orbit
– Extraocular muscles– Trauma– Mass
• Neuromuscular junction• Single cranial nerves• Multiple cranial nerves• Intraparenchymal problem
– INO– Gaze palsy
Oculomotor nerve (3)
Trochlear nerve (4)
Abducens nerve (6)
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Efferent Diagnoses
Oculomotor nerve (3)
Trochlear nerve (4)
Abducens nerve (6)
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Oculomotor CN Palsy
(Note elevation of left lid on gaze down and right – aberrant regeneration of the levator muscle.)
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Efferent Diagnoses
Oculomotor nerve (3)
Trochlear nerve (4)
Abducens nerve (6)
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Efferent Diagnoses
Oculomotor nerve (3)
Trochlear nerve (4)
Abducens nerve (6)
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Efferent Diagnoses
Oculomotor nerve (3)
Trochlear nerve (4)
Abducens nerve (6)
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Efferent Diagnoses
Oculomotor nerve (3)
Trochlear nerve (4)
Abducens nerve (6)
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Efferent Diagnoses• Orbit
– Extraocular muscles– Trauma– Mass
• Neuromuscular junction• Single cranial nerves• Multiple cranial nerves• Intraparenchymal problem
– INO– Gaze palsy
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Efferent Diagnoses• Orbit
– Extraocular muscles– Trauma– Mass
• Neuromuscular junction• Single cranial nerves• Multiple cranial nerves• Intraparenchymal problem
– INO– Gaze palsy
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Efferent Diagnoses• Orbit
– Extraocular muscles– Trauma– Mass
• Neuromuscular junction• Single cranial nerves• Multiple cranial nerves• Intraparenchymal problem
– INO– Gaze palsy
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Efferent Diagnoses• Orbit
– Extraocular muscles– Trauma– Mass
• Neuromuscular junction• Single cranial nerves• Multiple cranial nerves• Intraparenchymal problem
– INO– Gaze palsy
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Neuro-ophthalmology
• Afferent• Efferent• Other
Unusual faces
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Neuro-ophthalmology
• Afferent• Efferent• Other
Unusual scans
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Neuro-ophthalmology
• Afferent• Efferent• Other
Unusual teeth
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Neuro-ophthalmology
• Afferent• Efferent• Other
Unusual skin lesions
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Neuro-ophthalmology
• Afferent• Efferent• Other
Unusual postures
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Neuro-ophthalmology
• Afferent• Efferent• Other
And much, much more …