Neurology Set 2 Le2

Front 1

List the 4 deviations of primary gaze.

Back 1

1) Esotropia - nasal deviation

2) Exotropia - lateral deviation

3) Hypertropia - upward deviation

4) Hypotropia - downward deviation

Front 2

3 Structures that control vertical gaze in the pre-tectal area.

Back 2

1) Rostral median lateral fasciculus (rMLF)

2) INC (interstitial nucleus of Cajal)

3) Nucleus of fibers of posterior commissure

Front 3

Stimulation pathway for eye movement.

Back 3

1) PPRF and vestibular nuclei input to rMLF

2) rMLF projects ipsilaterally to CN3/4 nuclei and to contralateral rMLF nuclei through posterior commissure.

3) INC projects to opposite elevator muscles

Front 4

What does LASOT stand for or LR6SO4 or LAR6SOT4?

Back 4

Lateral Rectus - Abducens (CN6)

Superior Oblique - Trocheal (CN4)

-All other EOM muscles are CN3

Front 5

Supranuclear control of Horizontal Eye Movements - Saccades.

Back 5

1) Starts at Area 8 - Frontal gaze center/frontal eye fields, anterior to supplmntry motor cortex

2) Then ipsilateral internal capsule.

3) Decussation at midbrain

4) To Contralateral Pons PPRF (Pontine Paramedian Reticular formation)

5a) PPRF connects to adjacent CN6 which supplies ipsilateral lateral rectus

5b) PPRF also goes to contralateral MLF and connects to CN3 to supply contralateral medial rectus .

Front 6

Supranuclear control of pursuit.

Back 6

1) Starts at posterior parietal cortex.

2) Projects to ipsilateral Pons which is modulated by ipsilateral cerebellum.

Front 7

What would a lesion in the Area 8 (Frontal Eye Field cause? a lesion in the posterior parietal cortex?

Back 7

a) Area 8 lesion would mean patient cannot look at the opposite side, but can look on lesion side

b) Posterior parietal lesion would mean no pursuit.

Front 8

What is optokinetic nystagmus (OKN)?

Back 8

Repeated cycles of pursuit and refixation. Normal rhythmic jerky nystagmus when viewing a moving object.

Front 9

Describe afferent arm of pupillary light reflex.

Back 9

1) Retina photo receptors to bipolar to ganglion cells. Ganglion axons project as CN2.

2) Project through contralateral optic tract at optic chiasm.

3) Reaches Pretectal Nucleus (PN) in midbrain.

4) Most PN fibers connect to contralateral Edinger-Westphal Nucleus (EWN), part of CN3 complex.

Front 10

Decribe efferent arm of pupillary light reflex.

Back 10

1) From EWN to contralateral CN3.

2) CN3 projects to ciliary ganglion.

3) Ciliary ganglion supplies sphincter pupillae muscles that controls pupil constriction of iris.

Front 11

Of Adie's Tonic Pupil and Horner's Syndrome, which is more prominent in dim light and which is more prominent in bright light?

Back 11

Adie's Tonic Pupil is more prominent in bright light.

Horner's Syndrome (Ptosis, miosis, anhydrosis) is more prominent in dim light. Decreased pupillary size in miosis due to loss of sympathetic enervation of pupillary dilator muscle, so no dilation in dim room.

Front 12

What does the short ciliary nerve do? the long one?

Back 12

Short ciliary nerve is part of the parasympathetic pathway enervated by the EWN to the ciliary ganglion to stimulate sphincter pupillae muscle to constrict the pupil.

The long ciliary nerve is enervated by the hypothalamus to the intermedio-lateral nuclei at C8-T1 to the superior cervical ganglion that travels along the carotid artery to enervate the iris dilator ms.