视神经临床检查课件.pptVIP

NEURO-OPHTHALMOLOGY Clinical Examination Visual Acuity Colour Vision Visual Fields Pupils Normal Eye and Optic Disc The swollen optic disc The pale optic disc Papilloedema Disc swelling secondary to raised ICP Headache Worse in the morning Valsalva manouver Nausea and projectile vomiting Horizontal diplopia (VI palsy) Causes Space occupying lesion Intracranial hypertension Idiopathic Drugs Endocrine Severe hypertension Pupils First Order – Retina to Pretectal Nucleus in B/S (at level of Superior colliculus) Second Order – Pretectal nucleus to E/W nucleus (bilateral innervation!) Third Order – E/W nucleus to Ciliary Ganglion Fourth Order – Ciliary Ganglion to Sphincter pupillae (via short ciliary nerves) Pupil Constricted (mioisis) Sympathetic (pupillodilator) denervation Drugs Pilocarpine Morphine Dilated (mydriasis) Parasympathetic (pupilloconstrictor) denervation Lesion of the third CN Drugs Atropine Cocaine Horner’s Oculosympathetic paresis Ptosis Miosis Ipsilateral anhidrosis Does not dilate with cocaine 4% Sympathetic Pathway First Order – Posterior Hypothalamus to Ciliospinal centre of Budge (C8-T2) (Uncrossed in Brainstem) Second Order – Ciliospinal centre of Budge to Superior Cervical Ganaglion Third Order – Superior Cervical Ganglion to dilator pupillae muscle. (Close to ICA and joins V1 intracranially) Causes of Horner’s pupil Central – B/S lesions (tumours, vascular and MS) Syringomyelia, Lat. Med. Syn., S.C. ca. Preganglionic – Pancoast tumour, Carotid & Aortic aneurysms, Neck lesions/trauma. Postganglionic – Cluster headaches, Nasopharyngeal tumours, Otitis media, Cavernous sinus mass and ICA disease. Miscel