Clinical Application Flashcards
An image in the right visual field will be detected by _______ retinal ganglion cells on the left, and _______ RGCs on the right.
lateral, nasal
Blood supply to photoreceptors is __________ of ________ artery.
choroid, opthalmic
Blood supply to retina and distal CNII is ______ of _______ artery.
central artery of retina, ophthalmic artery
blood supply to CNII is _________ of ________ artery.
branches of ophthalmic artery, internal carotid
blood supply to optic chiasm is _________.
branches of anterior communicating artery and ACA
blood supply to optic tract is __________ of _________ artery.
anterior choroidal artery, internal carotid
Blood supply to LGN of thalamus is _______ of ______.
thalamogeniculate artery, PCA
Blood supply to retrolenticular limb of internal capsule is ________ of ________ artery.
anterior choroidal artery, internal carotid
blood supply to complete optic radiation is ________.
MCA stem
blood supply to superior parietal optic radiation is ________.
PCA
blood supply to inferior temporal optic radiation (includes Meyers’s Loop) is _________.
MCA inferior trunk
blood supply to the primary visual cortex is ________ of _______.
calcarine artery, PCA
A patient with complete visual field loss in left eye is found to have loss of pupillary light reflex in the left eye but normal pupillary light reflex in right eye. This is caused either by destruction to ________ or ________.
retina, optic nerve
A patient presents with complete blindness to left eye and pupillary light reflex maintained for both eyes. He is diagnosed with ______________.
retinitis pigmentosa (damage to photoreceptor layer only, without damage to ipRGC)
A patient is found to have a deficit in the central visual field in the right eye. This is caused by either _______ or ___________ and is referred to as ________.
irregular lesion of macula lutea, compression of optic nerve, scotoma
A patient gets a curtain sign loss of vision to the left eye, this is due to __________ and this occurs in the ___________.
detached retina, space between pigment epithelium and photoreceptor layer.
bitemporal heteronymous hemianopia is caused at the _________ and is most commonly due to __________
crossing of axons at the optic chiasm, pituitary tumor
A patient has right hemianopia in the left eye, this is most commonly caused by damage to ________ caused by ___________.
damage to lateral optic chiasm, aneurysm of internal carotid artery
right or left homonymous hemianopia is also referred to as ____________ and is caused by damage to __________, _____, _______, or ________.
contralateral homonymous hemianopia, optic tract, LGN, optic radation, primary visual cortex,
right or left homonymous hemianopia which is caused by damage to the optic tract is due to ________.
When it is caused by damage to the LGN it is due to __________.
When it is caused by damage to the primary visual cortex it is either due to _________ or ________.
occlusion of anterior choroidal artery, occlusion of thalamogeniculate artery, occlusion of calcarine artery, MCA stem or branches
A patient presents with bitemporal homonymous hemianopia with macular sparing, he most likely suffered occlusion of __________
calcarine artery
occlusion of the PCA leads to this kind of blindness: ________
This is because the ______ is affected.
complete visual field loss, LGN
A patient presents with left superior quadrantanopia, aka ___________.
This is caused by damage to _______ and is found in both eyes.
contralateral superior quadrantanopia, Meyer’s Loop
A patient has loss of direct and consensual pupillary response when light is shone in right eye, and is blind in the right eye. Where is the lesion?
optic nerve
A patient has partial loss of direct and consensual pupillary response with light in either eye, and has left homonymous hemianopia. Where is the lesion?
right optic tract
A patient has loss of right eye direct and consensual pupillary reflex with light shone in either eye. He has no visual field deficit, where is the lesion?
right oculomotor nerve
A patient has left homonymous hemianopia with no deficit in pupillary light reflex. Where is the lesion?
right optic radiation
Argyll Robertson pupil often results from this disease:
Tabes Dorsalis (neurosyphilis)
A patient presents with light-near dissociation, this means that his either his _________ or his _________ is spared while the other is absent.
pupillary light reflex, near response accommodation
A patient presents with light-near dissociation with sparing of his near response of accommodation. He also has small pupils of irregular size. He is found to have this disease: __________.
This pattern of sparing suggests bilateral damage to ______________.
tabes dorsalis (neurosyphilis), olivary pretectal nuclei or their projections
The pupillary light reflex involves these 6 structures in order:
optic nerve, optic tract, pretectal area, E-W nuclei, ciliary ganglion, pupillary sphincter muscle
The pupil constriction in accommodation near response is carried out by these 10 structures in order:
optic nerve, optic tract, LGN of thalamus, primary visual cortex, association visual cortex, supraocculomotor area, E-W nuclei, ciliary ganglion, pupillary sphincter muscle
light-near dissociation with loss of pupillary light reflex but sparing of near accommodation is found in these 3 diseases:
Argyll-Robertson Pupil, Parinaud Syndrome, Adie syndrome
Marcus Gunn Pupil is observed during this test:
swinging flashlight test
A patient presents with normal pupillary light reflex in both eyes, but during the alternating-light test the eyes appear to dilate. The patient also has left homonymous hemianopia. Where is the lesion and what is the name of this disorder?
Lesion in optic tract, Marcus Gunn Pupil (RAPD/relative afferent pupillary defect)
https://youtu.be/AFYY1qxF0T0
A patient is found to have Marcus Gunn Pupil (RAPD) without any vision loss, where is the lesion?
(lesion is after synapse with LGN) pretectal nuclei or posterior commissure
A patient presents with right homonymous hemianopia, right hemianesthesia of UE LE and face, right hemiplegia of the UE, LE, and lower face, loss of pupillary light reflex, oculomotor palsy, right sided ataxia, and right-sided tremor. She has a CT scan and this artery is found to be occluded:
left PCA stem
Occlusion of the PCA stem damages these 9 structures:
visual cortex, superior parietal optic radiation, LGN, VPL, VPM, crus cerebri, oculomotor nerve, red nucleus, substantia nigra
occlusion of thalmogeniculate artery leads to damage to these 3 structures
LGN, VPL, VPM
occlusion of calcarine artery leads to damage to this structure:
primary visual cortex
A patient presents to the emergency department with right homonymous hemianopia and right hemianesthesia of the UE, LE, and face. What artery is occluded?
left thalamogeniculate artery
A patient presents with left homonymous hemianopia with macular sparing, the ______ artery is found to be occluded.
right calcarine
A patient is seen with right-sided hemiplegia of the UE, LE, and lower face, as well as right hemianesthesia of UE, LE, and face. The patient is found to have occlusion of ___________ and the _______ was damaged.
left lenticulostriate arteries, left internal capsule
The five divisions of the MCA and what structures they supply are:
lenticulostriate —> internal capsule,
superior trunk —> primary somatomotor cortex, primary somatosensory cortex, frontal eye field (saccades)
inferior trunk —> inferior temporal optic radiation (including Meyer’s Loop)
distal stem —> primary somatomotor cortex, primary somatosensory cortex, frontal eye field, and inferior temporal optic radiation
proximal stem —> all of the above and COMPLETE optic radiation
A patient presents with right-sided hemiparesis of his UE, LE, and lower face. He also has right-sided hemianesthesia of UE, LE, and the whole face. There is no sign of visual field loss. What artery is likely occluded?
left MCA lenticulostriate arteries
A patient presents with left hemiparesis of his UE and lower face. He also has left anesthesia of his UE and face, as well as inability to shift his eyes to the left. What artery is occluded?
right MCA superior trunk
A patient shows up at your office during a down time and says she has weakness in her right arm and you notice that the right side of her mouth droops. She also complains that she lost sensation to her left arm and the right side of her face. What artery is probably occluded in this individual?
left MCA superior trunk
A patient comes to your office complaining that he thinks the upper right portion of his vision has been lost in both eyes. What artery is likely occluded?
left MCA inferior trunk (because it supplies only the inferior temporal optic radiation including Meyer’s Loop)
A patient comes to the emergency department unable to move his left arm or leg, and has a noticeable droop to the left side of his mouth.
He cannot feel the left arm or his left face. He cannot shift his gaze to the left and has loss of his upper left visual field.
What artery is occluded?
right MCA distal stem
A patient is completely screwed up on the right side of his body and face and has total loss of his right visual field. What artery is occluded?
left MCA proximal stem
The structure damaged in Marcus Gunn pupil is the _______ which is part of the pupillary light response pathway
posterior commissure (from either pretectal nucleus to both EW nuclei bilaterally)
In Argyll Robertson Pupil, the structures damaged are the _______ or the _______ of the pupillary light reflex pathway
olivary pretectal nuclei, posterior commissure
