قالوا سبحانك لا علم لنا إلا ما علمتنا إنك أنت العليم الحكيم 1292013 ID: 919500
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Slide1
Neuro-ophthalmology
اعوذ بالله من الشيطان الرجيم
{
قَالُواْ سُبْحَانَكَ لاَ عِلْمَ لَنَا إِلاَّ مَا عَلَّمْتَنَا
إِنَّكَ أَنتَ الْعَلِيمُ الْحَكِيمُ }
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MAHGOUB SALEEM
Slide2Neuro-ophthalmology
MAHGOUB SALEEM
MBBS (U of K) , DORCS (Eng.) ,
MRCOphth (UK),
FRCOphth
(UK) , FICS , FACS (USA)
SENIOR CONSULTANT OPHTHALMOLOGIST
ASSOCIATE PROFESSOR FACULTY OF MEDICINE AL NEELAIN UNIVERCITY
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MAHGOUB SALEEM
Slide3Neuro-ophthalmology
NEURO-OPHTHALMOLOGY
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Slide4Neuro-ophthalmology
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MAHGOUB SALEEMThe Visual Pathway:
1. Optic nerves
2. Optic chiasma
3. Optic tracts
4. Lateral
Geniculate
Bodies
5.Optic radiations6. Visual cortix
Slide5Neuro-ophthalmology
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MAHGOUB SALEEMThe Visual Pathway:
Optic nerves =
complete blindness
Slide6Neuro-ophthalmology
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MAHGOUB SALEEMThe Visual Pathway:
Optic
chiasma
=
bitemporal
/
binasal hemianopia
Slide7Neuro-ophthalmology
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MAHGOUB SALEEMThe Visual Pathway:
3. Optic tracts
4. Lateral
Geniculate
Bodies
5.Optic radiations
6. Visual cortixhomonymous hemianopia
Slide8Neuro-ophthalmology
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MAHGOUB SALEEMThe Visual Pathway:
Lesions of Visual Pathways
:
1. Trauma
2.
Vacular
3. Inflammatory4. Neoplasms5. Degenerative
Slide9Neuro-ophthalmology
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MAHGOUB SALEEMThe Visual Pathway:
Pupillary
reflexes
` direct ` indirect (consensual)
` near reflex
`convergence reflex
`accommodation reflex
Slide10Neuro-ophthalmology
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MAHGOUB SALEEMThe Visual Pathway:
Abnormalities of
pupillary
reactions:1 .
Amaurotic
light reflex
=
No DLR on affected side + No inderect P.reflex on good eye
Slide11Neuro-ophthalmology
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MAHGOUB SALEEMThe Visual Pathway:
Abnormalities of
pupillary
reactions:2. Efferent
pupillary
defect:
No
DPR+No IPR on affected eye: parasympathetic drugs,atropine, IIInerve palsy,internal ophthalmoloplegia
Slide12Neuro-ophthalmology
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MAHGOUB SALEEMThe Visual Pathway:
Abnormalities of
pupillary
reactions:3. Marcus Gunn pupil:
4.Argyil
Rebertson
pupil (ARP)
5. Adie`s tonic pupil
Slide13Neuro-ophthalmology
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MAHGOUB SALEEMHorner`s syndromeRelative Afferent Papillary Defect
Mid-brain pupil
Slide14Neuro-ophthalmology
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MAHGOUB SALEEMOptic nerve diseases:1.Papillitis
2.Acute Retrobulber
nuritis
3.Toxic amblyopia
4.Papilloedema
5.Optic Atrophy(1ry, 2ry)
Slide15Neuro-ophthalmology
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MAHGOUB SALEEMSymptomatic disturbance of vision:
Night blindness2. Day blindness3.
Colour
blindness4.
Amaurosis
5.
Amblyopia
6. Malingering blindness7. Hysterical blindness
Slide16Neuro-ophthalmology
is the subspecialty of both neurology and ophthalmology concerning concerning visual problems that are related to the nervous system
Neuro-ophthalmology1/29/2013
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Slide17Neuro-ophthalmology
Clinical Examination
Visual Acuity
Colour Vision
Visual FieldsPupils
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MAHGOUB SALEEM
Slide18Neuro-ophthalmology
The swollen optic disc
Papilloedema
Papillitis
Malignant hypertension
Ischaemic
optic neuropathy
Diabetic optic neuropathy
CRVO Intraocular inflammation
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MAHGOUB SALEEM
Slide19Neuro-ophthalmology
25 y.o. female
Reduced VA
Pain with eye movementColour desaturation
RAPD
Optic neuritis
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MAHGOUB SALEEM
Slide20Neuro-ophthalmology
Papilloedema
• Disc swelling secondary to raised ICP
• Headache – Worse in the morning – Valsalva maneuver
• Nausea and projectile vomiting• Horizontal diplopia (VI palsy)• Causes
– Space occupying lesion – Intracranial hypertension
• Idiopathic
• Drugs
• Endocrine
– Severe hypertension
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Slide21Neuro-ophthalmology
The pale optic disc
Congenital
Secondary to • raised ICP
• vascular • retinal disease • optic neuritis
• optic nerve compression
• trauma
Glaucoma
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MAHGOUB SALEEM
Slide22Neuro-ophthalmology
Pupil
Reflexes
( direct , consentiual)
APD
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MAHGOUB SALEEM
Slide23Neuro-ophthalmology
Pupil
Constricted (mioisis)
Sympathetic (
pupillodilator
)
denervation
Drugs ( Pilocarpine Morphine )
DM
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MAHGOUB SALEEM
Slide24Neuro-ophthalmology
Dilated (
mydriasis)
Parasympathetic (
pupilloconstrictor )
denervation
Lesion of the III Cranial Nerve
Drugs ( Atropine ,Cocaine )
Pupil
DM
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MAHGOUB SALEEM
Slide25Neuro-ophthalmology
Sympathetic Pathway
READ
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MAHGOUB SALEEM
Slide26Neuro-ophthalmology
Horner’s
(
Oculosympathetic paresis):–
Ptosis–
Miosis
– Ipsilateral
anhidrosis
– Does not dilate with cocaine 4%
Causes
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MAHGOUB SALEEM
Slide27Neuro-ophthalmology
Afferent & efferent papillary defects
APD
Argyll-Robertson pupil
Miotonic pupil (Adie’s syndrome)
Holmes-Adie syndrome
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MAHGOUB SALEEM
Slide28Neuro-ophthalmology
Cranial Nerve Palsies
III
IV VI
Ophthalmoplegia
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MAHGOUB SALEEM
Slide29Neuro-ophthalmology
Third nerve palsy
– Double vision
– Eye turned down & out– Ptosis– Dilated pupil & headache• Compressive lesion
causes
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MAHGOUB SALEEM
Slide30Neuro-ophthalmology
IV nerve palsy
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MAHGOUB SALEEM
Slide31Neuro-ophthalmology
Sixth nerve palsy
– Double vision
– Eye turned in
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MAHGOUB SALEEM
Slide32Neuro-ophthalmology
Internuclear Ophthalmoplegia
Defective adduction of the ipsilateral eye
Nystagmus of the contralateral (abducting) eye
NORMAL CONVERGENCE Causes
– Young patients
• Bilateral • Demyelination
– Older patients
• Unilateral
• Vascular,
• tumours1/29/201332MAHGOUB SALEEM
Slide33Neuro-ophthalmology
Myasthenia Gravis
• Fatigability
• Double vision• Lid twitch• Ptosis• Normal reflexes &
sensatio
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MAHGOUB SALEEM
Slide34Neuro-ophthalmology
Localising the lesion
• Monocular visual field defects indicate
lesions anterior to the optic chiasm• Bitemporal defects are the hallmark of
chiasmal lesions
• Binocular homonymous hemianopia
result
from lesions in the contralateral
postchiasmal
region
• Binocular quadrantanopias reflect optic tractlesions1/29/201334
MAHGOUB SALEEM
Slide35Neuro-ophthalmology
Localising the lesion
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MAHGOUB SALEEM
Slide36Neuro-ophthalmology
THANK YOU
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