Visual Motor Clinical Application Flashcards
A patient presents to you complaining that their right eye is looking down and out and has noticeable ptosis and mydriasis. He denies any weakness or numbness anywhere. What is likely the problem?
lesion of right CN III
The pathway for voluntary horizontal saccade is completed by these 5 structures in order:
left Frontal eye field —> right paramedian pontine reticular formation (PPRF) —> abducens nucleus (LMN then innervates right lateral rectus) + MLF —> oculomotor nucleus via MLF —> LMN innervates left medial rectus
A lesion to the frontal eye field (FEF) produces ___________ with __________
TRANSIENT contralateral gaze palsy, ipsilateral gaze preference
Lesion to the ________ produces ipsilateral HORIZONTAL gaze palsy with contralateral gaze preference
abducens nucleus
lesion to the _______ produces ipsilateral HORIZONTAL gaze palsy with contralateral gaze preference
PPRF
A lesion to the MLF produces _______ with _______ of unaffected eye
inability to adduct ipsilateral eye, nystagmus
A patient presents who cannot abduct his right eye, and cannot adduct his left eye. Additionally, he has nystagmus of left eye. Where is the lesion?
MLF and abducens nucleus and/or PPRF
A patient is diagnosed with __________ because she can only move her right eye to the right with nystagmus-like movement.
one-and-a-half syndrome
A patient has a lesion to her MLF and PPRF on the same side. She is diagnosed with ___________.
one-and-a-half syndrome
A patient presents to the emergency department complaining of inability to look upward. You note that he has large pupils with light-near dissociation.
He also has Collier’s sign and a convergence-retraction nystagmus. What is the diagnosis?
Parinaud Syndrome (Dorsal Midbrain Syndrome)
Abnormal eyelid retraction is referred to as __________
Collier’s sign
The most common cause of parinaud (dorsal midbrain syndrome) is _________
tumor of pineal gland that compresses vertical gaze centers and their pathways in the dorsal midbrain tectum
The vertical gaze centers in the dorsal midbrain tectum are as follows:
interstitial nucleus of Cajal, Rostral interstitial nucleus of the MLF
A patient presents with difficulty converging his eyes during a near-vision test. The damage could be to his ________
supraoculomotor area