2008-2009 Basic and Clinical Science Course: Section 5: by Lanning B. Kline, MD

By Lanning B. Kline, MD

A patient-centered method of the prognosis and therapy of significant neuro-ophthalmic stipulations. targeting very important providing signs, this publication leads the reader throughout the occasionally refined manifestations of neuro-ophthalmic sickness to anatomic localization of lesions and definitive prognosis. additionally contains an summary of the anatomy of the visible pathway, directions for carrying out the neuro-ophthalmic exam and acceptable use of diagnostic imaging experiences.

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CerA} and its branches; posterior temporal (Post. Temporal A); parieto-occipital artery; calcarine artery; posterior communicating persmith MJ. Neurovascular Neuro-Ophthalmology. A}. ) with permission from Ku- 20 . Neuro-Ophthalmology the posterior communicating artery (P. Com), which joins the vertebrobasilar circulation to the carotid anteriorly. The connecting artery parallels the course of CN III, which explains the high frequency of third nerve palsy with aneurysms of the P. Com. As the distal PCA courses around the brain stem, it gives off a parieto-occipital branch before terminating in the calcarine branch, which supplies the primary visual cortex (Fig 1-9).

Vertebral artery or PICA occlusion is associated with Wallenberg lateral medullary syndrome, which manifests as ipsilateral Horner syndrome; skew deviation; cranial nerve V, IXIX paresis; and contralateral body numbness. There is no extremity weakness with the syndrome. The second set of circumferential arteries are the anterior inferior cerebellar arteries (AICA). The AICA arise from the caudal basilar artery and supply the area of the pontomedullary junction of the brain stem, as well as the cerebellum, distally.

Pontine branches of the basilar artery also supply the proximal portions of the cranial nerves (particularly the trigeminal) as they exit. The distal 2 sets of circumferential arteries consist of the superior cerebellar (SCA) followed by the posterior cerebral arteries (PCA), representing the terminal branches of the basilar artery at the level of the midbrain. Perforators from the proximal SCA partially supply the third nerve nucleus and its fascicles. In addition, small branches often supply the trigeminal root.

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