OCEAN MEDICAL CENTER
STROKE SERIES
AWARENESS OF VISUAL SEQUELLA OF STROKES
NORMAN P EINHORN OD MS FAAO
Diplomate American Board of OptometryNational & International Lecturer NORPast AOA Membership Chair SVSPast NJSOP Board MemberPast Chair NJSOP Rehabilitation SectionSenior member Vision Panel NJ MVCExecutive Committee Belmar Business PartnershipStaff Consulting Privileges 5 Acute Rehab Hosptals
Visual Deficits Post CVAto watch for
1. Field Loss or Visual Inattention2. Diplopia or Binocular Deficits3. Spatial Deficits4. Dry eye caused by poor lid closure,
partial CN7 or CN 5 Ophthalmic Branch loss
5. Inability to read or scan
RETINA
STRUCTUREFUNCTION
RETINAL STRUCTURE
GANGLION CELS
THREE PARALLEL PATHWAYS
BASE OF BRAIN
AFFERENT PAHTWAY
RETINO GENICULATE CALCARINE PATHWAY
RETINO GENICULO CALCARINE PATHWAY
OPTIC TRACTS AND LATERAL GENICULATE
GANGLION CELL INPUT TO LGN LAYERS
THALMUS &
LATERAL GENICULATE
• Specific relay nuclei• VA ventral anterior (motor)• VL ventral lateral (motor)(somatosensory) • VPM ventral posteromedial (trigeminal)• MG medial geniculate (body) nucleus (auditory)• LG lateral geniculate (body) nucleus (vision)• Association nuclei• DM dorsomedial nucleus (prefrontal cortex)• AN anterior nucleus (limbic lobe)• P pulvinar (visual cortex) • LP lateral posterior (parietal lobe)• Nonspecific nuclei• IL intralaminar
OPTIC RADIATIONS
PRIMARY CORTEX – VISUAL ORGANIZATION
THREE PARALLEL PATHWAYS
PRIMARY CORTEX – VISUAL ORGANIZATION
Territories Supplied by the Cerebral Arteries
SHORT ASSOCIATION FIBERS
LONG ASSOCIATION FIBERS
AFFERENT PATHWAY
EXTRA GENICULATE PATHWAYMagno cellular
EXTRA GENICULATE PAHTWAY
EXTRA GENICULATE PATH
Although this figure again illustrates the optic
radiation and the lateral geniculate nucleus
[a nucleus with six layers], the focus is now on the synaptic terminations of
other visual fibers.Some of the visual
information is relayed to the superior colliculus for
visual reflex responses. Other fibers relay in the
pre-tectal region which is the locus for the pupillary
light reflex. The oculomotor nucleus (including the
parasympathetic component) is not shown
here.
RETINO SUPERIOR COLLICULUS
SUPERIOR COLLICULUS FIBERS AND MOTOR FIBERS
AFFERENT PATHWAY
RETINO HYPOTHALAMIC PATHWAY
AFFERENT PATHWAY
PRE TECTAL PATHWAY
Visual Field Loss By
Deficit Areas
Review
EFFERENT
EYE MOVEMENT
CLASSES OF HUMAN EYE MOVEMENT
VESTIBULAR- HOLDS IMAGES OF THE SEEN WORLD STEADY ON THE RETINADURING BRIEF HEAD ROTATIONS
VISUAL FIXATION- HOLDS THE IMAGE OF A STATIONARY OBJECT ON THE FOVEA
OPTOKINETIC- HOLDS AN IMAGE OF THE SEEN WORLDSTEADY ON THE RETINADURING SUSTAINED HEAD ROTATION
CLASSES OF HUMAN EYE MOVEMENT
SMOOTH PURSUIT- HOLDS AN IMAGE OF A SMALL MOVING TARGET ON THE FOVEA; OR HOLDS THE IMAGE OF A NEAR TARGET ON THE RETINA DURINGLINEAR SELF MOTION
NYSTAGMUS QUICK PHASE- RESET THE EYES DURING PROLOGED ROTATION AND DIRECT GAZE TOWARD THE ONCOMING VISUAL SCENE
CLASSES OF HUMAN EYE MOVEMENT
SACCADES- BRINGS IMAGES OF OBJECTS OF INTEREST ONTO THE FOVEA
VERGENCE- MOVES THE EYES IN OPPOSITE DIRECTIONSSO THAT IMAGES OF A SINGLE OBJECTARE PLACED OR HELD SIMULTANIOUSLY ON BOTH FOVEAS.
SMOOTH PURSUITS
SACCADES
VESTIBULAR
VERGENCE EYE MOVEMENT
SUPRA AND INFRA NUCLEAR PATHWAYS
VENTRAL BRAIN STEM• This photographic
view of the brainstem is shown as a parallel to the illustration shown in the previous illustration - the same structures are indicated.
• Various cranial nerves (CN)
• are still attached. The
• cerebellum, with its characteristic folia, is still attached.
DORSAL BRAIN STEM
• The brainstem is shown from the dorsal (posterior) perspective, with the cerebellum removed (and the middle cerebellar peduncles have been cut).
• In particular, one should note the colliculi (superior and inferior) of the midbrain, the sensory relay nuclei (cuneatus and gracilis) of the medulla, the fourth ventricle, and the emerging cranial nerves that can be seen from this perspective.
CN 3,4,6 IN PONTINE REGION
CN 3,4.6 TRACTS THROUGH BRAIN
EOM ACTIONS
Visual Deficits Post CVAto watch for
1. Field Loss or Visual Inattention2. Diplopia or Binocular Deficits3. Spatial Deficits4. Dry eye caused by poor lid closure,
partial CN7 or CN 5 Ophthalmic Branch loss
5. Inability to read or scan
NO MAS