视神经及视路疾病 - 上海交通大学医学院精品课程.pptVIP

Neuro-ophthalmology sjtu ophthalmology 樊莹 Neuro-ophthalmology an important sensory end organ intimatedly related to the brain cranial nerves: 50％ II、III、IV、V、VI、VII cranial nerve fiber: 38％ intracranial diseases: 65％ vision loss blindness die diagnosis including etiology and location optic neuropathy structure of retina nerve fiber layer sensory visual pathway anatomy of the optic nerve from optic disc to optic chiasm length：45~50mm including：intraglobe 1 mm intraorbit 25~30 mm optic canal 5 mm intracrania 10 mm histology of the optic nerve comprised by ganglion cell axons covered by meninges (3 layers) lack of Schwanns cells hard to rebuild to valuate optic nerve morphology：ophthalmoscope ultrasonic X-ray CT MRI function：vision acuity visual field pupil test VEP+ERG dark adaption colour perception visual field testing steady fixation measure the comdined function of the retina “peripheral vision” 30°central visual field 30°peripheral visual field electrophysiologic testing electrooculogram EOG electroretinogram ERG visual evoked potential VEP pupil light reflex optic neuropathy inflammatory： optic neuritis vascular： anterior ischemic optic neuropathy (AION) neoplastic infiltration： glioma, leukaemia, lymphoma, meningeal carcinomatosis others： optic atrophy、papilledema Optic neuritis duo to a variety of causes the most common is demyelination else: immune-mediated direct infections granulomatous optic nueropathy contiguous inflammatory disease demyelinative optic neuritis clinical features: chiefly in women(3:1) chiefly in white associated with multiple sclerosis subacute(2~7days) color vision and contrast sensitivity