Transcript opthalmoplasia

Opthalmoplagia
opthalmoparesis
Eye movement
 Motor
 Motor pathway
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coordination
cerebellum
basal ganglia
vestibular system
 Paralysis
 opthalmoparesis
nystagmus
eye movement(motor) pathway
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Supranuclear
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brainstem
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Internuclear
Nuclear
Craineal nerve
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NMJ
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muscle
Conjugate gaza palsy
 Horizontal: cortex &pontine
 Unilateral restriction of voluntary gaze to
one side .
 Frontal damage: eye look to the lesion
 epilepsy: eye look away
 Pontine: abducent n or PPRF…impair look
to site of lesion, look away ,towered
hemiplasia
Vertical gaze palsy
 Up –gaze palsy:pretectal lesion with damage to
post comissure
 Pretectal: parinaud syndrom: (paralysis of upward
gaze,lid retraction,impaired converg,convergence
retraction nystagmus,light near dissosiation)
 Causes:
tumer,hydrocephalus 3rd v compress on PC, stroke
of thalamic &midbrain ,MS,truma,wilson,syphlis
,TB,drug neuroliptic,barbiturate,tegretol)
Oculogyric crisis:
Defention:episodic, spasmodic,conjugate
ocular deviation,up wared &lateral.
Accompanied with mental changes, may
associate with dystonia or other dyskinesia
 Causes: encephalities lethargica,
degenerative dis eg familial parkison, head
truma,neurosyphlis,MS,ataxia
telengictasia,drug:neuroleptic
Disconjucate eye movement
Internuclear pathology
 INO:
 Damage to the MLF between 3&6 nerve
,impair transmisstion of impulse to the
ipsilateral medial rectus
 Impair ipsilateral adduction, abduction
nystagmus
 No visual symptoms,other diplopia
 Nystagmus cause not clear but may
adaptive
INO
 Causes:
MS,brainstem infarct,truma,
The one and half syndrome
 Impaired congucate gaze to one side &
impair adduction to the other side
 PPRF or abducent nucleus + MLF
Nuclear ,nerve control
 Double vision
 Brain stem contain the lower motor control
of the eye movement
 3rd supply all except:
 4th SO, 6th LR
Nuclear (brain stem)
 Long tract signs
 Crossed phenomena
 Causes:
 Tumor,MS,stroke
cranial nerve pathology
 ocular neuropathy :
 Compressive :localization acoording to
stations
 Non compressive: trauma, DM, vasculitis,
demyelinating ( miller fisher syndrome),
infection diphtheria
Ocular nerves pathway
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3,4,6th nerve
subarachnoid space
cavernous sinus
Superior orbital fissure
orbit
At sub arachnoid
 Complete 3rd n palsy +_ other CN
 Causes:
 Posterior communicating aneurysm 3rd,superior
cerebellur 4th nerve
 Tumor :meningeoma ,shwanoma
 Trauma
 Meningitis
 SAH
 Uncal herniation
At cavernous sinus
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Painful or painless if medially +_ 4,5,6
+ Horner syndrome
Causes:
Cavernous sinus thrombosis
Dural carotid cavernous sinus fistula
Carotid aneurysm lateral painless
Pituitary adenoma, apoplexy
At superior orbital fissure
 3 +_,4,5.6 (no horner ,no maxillary nerve)
 Causes:
 Tolosa hunt syndrome
At the orbit
 Optic n visual loss, proptosis, swelling of lid
,chemosis
 Causes:
 Trauma ,tumor, cellulites
Imp note
 Many lesion extend from cavernous sinus to
orbital apex and vice viscera
 Combined 3rd n & sympathetic denervation
is pathognomonic for cavernous sinus lesion
neuromuscular
 Myasthenia graves (flactuation)
 botulism
muscle
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Hereditary :mitochondrial
acquired
trauma
Thyroid
inflammatory