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Opthalmoplagia opthalmoparesis

Opthalmoplagia opthalmoparesis. Eye movement. Motor coordination Motor pathway cerebellum basal ganglia vestibular system Paralysis nystagmus

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Opthalmoplagia opthalmoparesis

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  1. Opthalmoplagiaopthalmoparesis

  2. Eye movement • Motorcoordination • Motor pathway cerebellum • basal ganglia • vestibular system • Paralysis nystagmus • opthalmoparesis

  3. eye movement(motor) pathway • Supranuclear • brainstem Internuclear • Nuclear • Craineal nerve • NMJ • muscle

  4. 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

  5. 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)

  6. 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

  7. Disconjucate eye movement

  8. 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

  9. INO • Causes: MS,brainstem infarct,truma,

  10. The one and half syndrome • Impaired congucate gaze to one side & impair adduction to the other side • PPRF or abducent nucleus + MLF

  11. Nuclear ,nerve control • Double vision • Brain stem contain the lower motor control of the eye movement • 3rd supply all except: • 4th SO, 6th LR

  12. Nuclear (brain stem) • Long tract signs • Crossed phenomena • Causes: • Tumor,MS,stroke

  13. cranial nerve pathology • ocular neuropathy : • Compressive :localization acoording to stations • Non compressive: trauma, DM, vasculitis, demyelinating ( miller fisher syndrome), infection diphtheria

  14. Ocular nerves pathway • 3,4,6th nerve • subarachnoid space • cavernous sinus • Superior orbital fissure • orbit

  15. 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

  16. At cavernous sinus • 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

  17. At superior orbital fissure • 3 +_,4,5.6 (no horner ,no maxillary nerve) • Causes: • Tolosa hunt syndrome

  18. At the orbit • Optic n visual loss, proptosis, swelling of lid ,chemosis • Causes: • Trauma ,tumor, cellulites

  19. 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

  20. neuromuscular • Myasthenia graves (flactuation) • botulism

  21. muscle • Hereditary :mitochondrial • acquired • trauma • Thyroid • inflammatory

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