Opthalmoplagia opthalmoparesis

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Opthalmoplagiaopthalmoparesis
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Eye movement

• Motor
  coordination
• Motor pathway cerebellum
• basal
  ganglia
• 
  vestibular system
• Paralysis nystagmus
• opthalmoparesis
  

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eye movement(motor) pathway

• Supranuclear
• brainstem
  Internuclear
• 
  Nuclear
• Craineal nerve
• NMJ
• muscle

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Conjugate gaza palsy

• Horizontal cortex pontine
• Unilateral restriction of voluntary gaze to one
  side .
• Frontal damage eye look to the lesion
• epilepsy eye look away
• Pontine abducent n or PPRFimpair look to site
  of lesion, look away ,towered hemiplasia

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Vertical gaze palsy

• Up gaze palsypretectal lesion with damage to
  post comissure
• Pretectal parinaud syndrom (paralysis of upward
  gaze,lid retraction,impaired converg,convergence
  retraction nystagmus,light near dissosiation)
• Causes
  tumer,hydrocephalus 3rd v compress on PC,
  stroke of thalamic midbrain ,MS,truma,wilson,syph
  lis ,TB,drug neuroliptic,barbiturate,tegretol)

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Oculogyric crisis

• Defentionepisodic, spasmodic,conjugate ocular
  deviation,up wared lateral. Accompanied with
  mental changes, may associate with dystonia or
  other dyskinesia
• Causes encephalities lethargica, degenerative
  dis eg familial parkison, head truma,neurosyphlis,
  MS,ataxia telengictasia,drugneuroleptic

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Disconjucate eye movement
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Internuclear pathology

• INO
• Damage to the MLF between 36 nerve ,impair
  transmisstion of impulse to the ipsilateral
  medial rectus
• Impair ipsilateral adduction, abduction nystagmus
• No visual symptoms,other diplopia
• Nystagmus cause not clear but may adaptive

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INO

• Causes
  MS,brainstem infarct,truma,

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The one and half syndrome

• Impaired congucate gaze to one side impair
  adduction to the other side
• PPRF or abducent nucleus MLF

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Nuclear ,nerve control

• Double vision
• Brain stem contain the lower motor control of the
  eye movement
• 3rd supply all except
• 4th SO, 6th LR

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Nuclear (brain stem)

• Long tract signs
• Crossed phenomena
• Causes
• Tumor,MS,stroke

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cranial nerve pathology

• ocular neuropathy
• Compressive localization acoording to stations
• Non compressive trauma, DM, vasculitis,
  demyelinating ( miller fisher syndrome),
  infection diphtheria

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Ocular nerves pathway

• 3,4,6th nerve
• subarachnoid space
• cavernous sinus
• Superior orbital fissure
• orbit

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At sub arachnoid

• Complete 3rd n palsy _ other CN
• Causes
• Posterior communicating aneurysm 3rd,superior
  cerebellur 4th nerve
• Tumor meningeoma ,shwanoma
• Trauma
• Meningitis
• SAH
• Uncal herniation

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At cavernous sinus

• Painful or painless if medially _ 4,5,6
• Horner syndrome
• Causes
• Cavernous sinus thrombosis
• Dural carotid cavernous sinus fistula
• Carotid aneurysm lateral painless
• Pituitary adenoma, apoplexy

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At superior orbital fissure

• 3 _,4,5.6 (no horner ,no maxillary nerve)
• Causes
• Tolosa hunt syndrome

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At the orbit

• Optic n visual loss, proptosis, swelling of lid
  ,chemosis
• Causes
• Trauma ,tumor, cellulites

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Imp note

• Many lesion extend from cavernous sinus to
  orbital apex and vice viscera
• Combined 3rd n sympathetic denervation is
  pathognomonic for cavernous sinus lesion

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neuromuscular

• Myasthenia graves (flactuation)
• botulism

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muscle

• Hereditary mitochondrial
• acquired
• trauma
• Thyroid
• inflammatory