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NEURO OPHTHALMOLOGY. Pavel Stodůlka. VISU AL PATHWAY. VISUAL PATHWAY. Clinical point of view :. 1. RETINA 2. OPTICAL NERVE 3. CHIASMA 4. OTICAL TRACT 5. VISUAL CORTEX – area striata. VISUAL PATHWAY. Anatomical point of view:. 1. NEURON – cones & rods
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NEURO OPHTHALMOLOGY Pavel Stodůlka
VISUAL PATHWAY Clinical point of view: 1. RETINA 2. OPTICAL NERVE 3. CHIASMA 4. OTICAL TRACT 5. VISUAL CORTEX – area striata
VISUAL PATHWAY Anatomical point of view: 1. NEURON – cones & rods 2. NEURON – bipolar cells of retina 3. NEURON - ganglioncells(nervus opticus) 4. NEURON – cells from corpus geniculatum lat. (radiatio optica)
OPTIC HEAD PATHOLOGY 1. PAPILLEDEMA 2. NEURITIS 3. NEUROPATHY 4. OPTIC HEAD ATROPHY
DIRECT OPHTHALMOSCOPE
DISC: sharp edges flat physiological colour
OPTIC HEAD PATHOLOGY 1. PAPILLEDEMA 2. NEURITIS 3. NEUROPATHY 4. OPTIC HEAD ATROPHY
PAPILLEDEMA It is not a disease buta sign of increased intracranial (or intraorbital) pressure.
PAPILLEDEMA “Champane cork“ • prominence • blurry edges • haemorhagies
DISC: sharp edges flat physiological colour
PAPILLEDEMA Obvious pathology on the disc but no visual problems.
Increased intracranial pressure Papilledema is present BILATERAL.
Increased intracranial pressure ??
Increased intracranial pressure Intracranial expansion
PAPILLEDEMA Absolute CONTRAINDICATION of lumbal puncture.
OPTIC HEAD PATHOLOGY 1. PAPILLEDEMA 2. NEURITIS 3. NEUROPATHY 4. OPTIC HEAD ATROPHY
NEURITIS 1. NEURITIS INTRAOCULARIS 2. NEURITIS RETROBULBARIS
NEURITIS INTRAOCULARIS 1. blurry edges of optic head 2. haemorhagies 3. decreased visual accuity
neuritis intraocularis neuroretinitis
NEURITIS INTRAOCULARIS Ethiology: brain infections, meningitis, infectious diseases
NEURITIS RETROBULBARIS Marked visual deterioration, but no pathologies on optic head.
NEURITIS RETROBULBARIS Patient does not see anything, doctor does not see anything too.
NEURITIS RETROBULBARIS Ethiology: Sclerosis multiplex
OPTIC HEAD PATHOLOGY 1. PAPILLEDEMA 2. NEURITIS 3. NEUROPATHY 4. OPTIC HEAD ATROPHY
OPTIC HEAD PATHOLOGY 1. PAPILLEDEMA 2. NEURITIS 3. NEUROPATHY 4. OPTIC HEAD ATROPHY
NEUROPATHIES DEGENERATIONS
NEUROPAHTIES 1. inherited 2. acquired - a) exogenous - b) endogenous
EXOGENOUS NEUROPATHIES 1. ethanol 2. tabacco 3. psychopharmacs 4. methanol
METHANOL INTOXICATION Patient is sleepy the next day with vomiting and high heart rate. Delirium and spasms are signs of bad prognosis. If they survive they become blind.
METHANOL INTOXICATION Acute event with dramatic scenario. 10 ml of methanol is enough for intoxication.
METHANOL INTOXICATION Methanol molecule is been split and products are toxic for retinal ganglion cells.
NEUROPAHTIES 1. inherited 2. acquired - a) exogenous - b) endogenous
ENDOGENOUS NEUROPATHIES 1. diabetics 2. pregnancy and brest feeding 3. anaemia 4. undernourishment
OPTIC HEAD PATHOLOGY 1. PAPILLEDEMA 2. NEURITIS 3. NEUROPATHY 4. OPTIC HEAD ATROPHY
OPTIC HEAD PATHOLOGY 1. PAPILLEDEMA 2. NEURITIS 3. NEUROPATHY 4. OPTIC HEAD ATROPHY
Optic nerve atrophy Manifestation of pathology of 2. neuron of visual pathway.
Optic nerve atrophy pale disc
Optic nerve atrophy ATROPHIA SIMPLEX ATROPHIA GLAUCOMATOSA ATROPHIA FLAVA
Glaucomatous disc
Pavel Stodůlka, MD, PhD stodulka@lasik.cz www.LASIK.cz BREAK !