OCEAN MEDICAL
CENTER
STROKE SERIES
AWARENESS OF VISUAL
SEQUELLA OF STROKES
NORMAN P EINHORN OD MS FAAO
Diplomate American Board of Optometry
National & International Lecturer NOR
Past AOA Membership Chair SVS
Past NJSOP Board Member
Past Chair NJSOP Rehabilitation Section
Senior member Vision Panel NJ MVC
Executive Committee Belmar Business
Partnership
Staff Consulting Privileges 5 Acute Rehab
Hosptals
Visual Deficits Post CVA
to watch for
1.
2.
3.
4.
Field Loss or Visual Inattention
Diplopia or Binocular Deficits
Spatial Deficits
Dry eye caused by poor lid closure,
partial CN7 or CN 5 Ophthalmic
Branch loss
5. Inability to read or scan
RETINA
STRUCTURE
FUNCTION
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 PATHWAY
Magno 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
PROLOGED ROTATION AND DIRECT GAZE
VISUAL SCENE
DURING
TOWARD THE ONCOMING
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 CVA
to watch for
1.
2.
3.
4.
Field Loss or Visual Inattention
Diplopia or Binocular Deficits
Spatial Deficits
Dry eye caused by poor lid closure,
partial CN7 or CN 5 Ophthalmic
Branch loss
5. Inability to read or scan
NO MAS