Pupillary control - Horner syndrome Flashcards

1
Q

miosis mechanism - 1st neuron

A

Edinger-Westphal nucleous to ciliary ganglion via CN III

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2
Q

miosis mechanism - 2st neuron

A

short ciliary nerves to pupillary sphincter muscles

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3
Q

pupillary sphincter muscles - receptors

A

M3

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4
Q

A consensual reflex is

A

any reflex observed on one side of the body when the other side has been stimulated

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5
Q

Pupillary light reflex - mechanim

A

Light in EITHER retina sends signals via CN II (and chiasm and tract) to pretectal nuclei in midbrain that activates bilateral Edinger-Westphal nucleous –> Pupils contract bilaterally (consensual reflex)

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6
Q

Pupillary light reflex - direction of the signal from retina to Edinger-Westphal nucleous

A

light –> retina –> optic nerve optic chiasm –> optic tract –> pretectal nuclei (midbrain) –> bilateral Edinger-Westphal nucleous

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7
Q

CN that participate in Pupillary light reflex

A
optic nerve (CN II)
Oculomotor nerve (CN III)
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8
Q

miosis - number of neurons

A

2

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9
Q

mydriasis - number of neurons

A

3

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10
Q

mydriasis - 1st neuron (beginning and end)

A

hypothalamus to ciliospinal center of Budge (C8-T2)

Synapse in the lateral horn

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11
Q

mydriasis - 2nd neuron - direction

A

exit T1 - travels along cervical sympathetic chain near lung apex, sublavian vessels - superior cervical ganglion

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12
Q

mydriasis - 3rd neuron - direction

A

superior cervical ganglion - plexus along internal carotid through cavernous sinus - enters orbit as LONG CILIARY NERVE - sypathetic fibers also innervate smooth muscle of eyelids (minor retractors) and sweat glands of forehead and face

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13
Q

mydriasis - 3rd neuron - innervate

A
  1. pupillary dilator muscle
  2. smooth muscle of eyelids (minor retractors)
  3. sweat glands of forehead and face
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14
Q

mydriasis - 3rd neuron is going through

A

cavernous sinus

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15
Q

long vs short ciliary nerve - according to eye control

A

long: 3rd neuron of Mydriasis
short: 2nd neuron of Miosis

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16
Q

Marcus Gunn pupil - clinical finding

A

decreased bilateral pupillary constriction when light is shone in affected eye relative to unaffected eye

17
Q

Marcus Gunn pupil - mechanism

A

Afferent pupillary defect due to optic nerve damage or severe retinal injury

18
Q

Marcus Gunn pupil is tested with

A

swinging flashlight test

19
Q

Some causes of Horner syndrome

A
  1. spinal cord above T1: Brown-Sequard syndrome (cord hemisection), Late stage syringomegalia
  2. Pancoast tumor
  3. Lateral medullary (Wallenberg) syndrome
  4. Infernal carotid dissection
  5. Carvenous sinus syndrome
20
Q

Horner syndrome - findings

A
  1. ptosis
  2. anhidrosis and flushing
  3. Miosis
21
Q

Area of pretectal nucleus

A

Upper midbrain

22
Q

Long ciliary nerve is going to the eye next to

A

V1 (opthalmic division of trigeminal nerve)

23
Q

Superior tarsal muscle is AKA

A

Müller’s muscle.