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Title | Description | Type |
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Right-sided Pseudo-Horner's Syndrome | Right-sided pseudo-Horner's syndrome in an 8-month-old infant referred because her mother had noted a larger pupil on the left for a few months and her pediatrician thought the right upper lid was droopy. Both pupils reacted normally to light and darkness, the degree of anisocoria was similar in bot... | Image |
27 |
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An Enhancing Bladder Metastasis Involving the Tectum of the Midbrain | Magnetic resonance image of an enhancing bladder metastasis involving the tectum of the midbrain of a 56-year-old man who developed double vision resulting from skew deviation and divergence insufficiency. He also had a left-sided relative afferent pupillary defect measuring 1.4 log units but showed... | Image |
28 |
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Light-near Dissociation | Light-near dissociation in a 51-year-old woman with multiple sclerosis who experienced double vision for 1 week. Her pupils are 5 mm in diameter in room light (top), react poorly in response to direct light reaction (middle), but constrict promptly in response to near stimulation (bottom). She also ... | Image |
29 |
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The Normal Pupillary Light Reflex | The normal pupillary light reflex is initiated following exposure to light. After a brief latency, both the right (solid line) and left (broken line) pupil constrict, then undergo a small amount of redilation (escape), followed by oscillations (hippus) if the light is sustained. Hippus is not a path... | Image |
30 |
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4-54a -Optic Neuropathy, Ischemic: Posterior | | Image |
31 |
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4-54b - Optic Neuropathy, Ischemic: Posterior | | Image |
32 |
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3-3 - Bergmeister Papilla | | Image |
33 |
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3-4 - Tilted Disc | Tilted discs are normal variants caused by oblique insertion of the optic nerve to the globe. They can be and frequently are mistaken for papilledema. In this case the superior edge of the disc is tilted and appears elevated. This disc exhibits a nasal inferior tilt. | Image |
34 |
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3-5b - Myelinated Nerve Fibers | Myelinated nerve fibers are frequently confused with papilledema. The feathery edge of the myelinated fibers that conceal the disc and vessel should provide the clue. These myelinated nerve fibers make the disc look blurred. | Image |
35 |
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3-33b - Papilledema Stages | Grading Papilledema: Stage 2 = Elevation of the disc margin 360 degrees. Since the blood vessels at the disc margin are not swollen or obscured, this disc could be mistaken for pseudo-papilledema. | Image |
36 |
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2-37a - Vascular Features | When looking at the disc, the central retinal artery and vein should be visible. The central retinal artery is usually slightly narrower than the vein. When the central retinal artery goes though the lamina cribrosa, the artery becomes smaller because of diminution of the muscular layer and loss of ... | Image |
37 |
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Location of Pupillomotor Fibers | Location of pupillomotor fibers are depicted as dark regions on cross-sections of the right (R) and left (L) oculomotor nerve at various locations along its course, including its emergence from the brain stem in the interpeduncular fossa (1), the midsubarachnoid segment (2), the level of the dorsum ... | Image |
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Anatomy of the Pupillary Light Reflex Pathway | Anatomy of the pupillary light reflex pathway. (Miller NR: Walsh And Hoyt's Clinical Neuro-Ophthalmology, p 421. Vol 2, 4th ed. Baltimore: Williams & Wilkins, 1985, with permission.) | Image |
39 |
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The Course of the Postganglionic Segment of the Oculosympathetic Fibers from the Internal Carotid Artery | The course of the postganglionic segment of the oculosympathetic fibers from the internal carotid artery (ICA) to the orbit is depicted as a dotted line. Note that they briefly join the abducens nerve (cranial nerve VI) before joining the nasociliary branch of the of the ophthalmic division of the t... | Image |
40 |
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Anatomy of the Oculosympathetic Pathway | Anatomy of the oculosympathetic pathway. (Maloney WF, Younge BR, Moyer NJ: Evaluation of the causes and accuracy of pharmacologic localization in Horner's syndrome. Am J Ophthalmol 1980;90:394-402, Ophthalmic Publishing Company with permission.) | Image |
41 |
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2-37b - Vascular Features | When looking at the disc, the central retinal artery and vein should be visible. The central retinal artery is usually slightly narrower than the vein. When the central retinal artery goes though the lamina cribrosa, the artery becomes smaller because of diminution of the muscular layer and loss of ... | Image |
42 |
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Pupillogram of a Healthy Young Subject | Pupillogram of a healthy young subject showing continuous pupillary oscillations of both pupils when light is sustained, indicated by the dark arrow at the top of the recording. Note that the oscillations of the pupils are synchronous and demonstrate variable amplitude and frequency. This pattern of... | Image |
43 |
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Relationship Between Age and Pupil Size | Relationship between age and pupil size, determined using an infrared flash photograph technique with subjects placed in darkness for 3 minutes. The numbers above the abscissa indicate the number of subjects tested in each age range. (Reprinted with permission of Loewenfeld IE: "Simple, central" ani... | Image |
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Left-sided Horner's Syndrome with an Acquired Preganglionic Localization | Left-sided Horner's syndrome in a 12-year-old girl with an acquired preganglionic localization based on clinical and pharmacologic testing. The cause remained undetermined after extensive radiologic investigations. Left-sided ptosis and miosis are evident in room light (top), and the degree of aniso... | Image |
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Bilateral Iris Colobomas (B) | Bilateral iris colobomas. B. Bilateral colobomatous defects of the inferonasal retina (black arrows) are also present, as shown in the right eye. | Image |
46 |
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Flow Chart for Sorting Out Anisocoria - Bright Light and Darkness | Flow chart for sorting out anisocoria based initially on how it is influenced by bright light and darkness. | Image |
47 |
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Flow Chart for Sorting Out Anisocoria - Direct Light Reaction of the Pupil | Flow chart for sorting out anisocoria based initially on the integrity of the direct light reaction of the pupil. | Image |
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Assessment of an Afferent Pupillary Defect When Only One Iris is Functional | Assessment of an afferent pupillary defect when only one iris is functional. In this example, a right-sided parasellar tumor is compressing both the optic and oculomotor nerves, causing an optic neuropathy and a pupil-involving third crainial nerve palsy. The pupil on the affected side has both an a... | Image |
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Hand-held Equipment Used to Measure a Relative Afferent Pupillary Defect | Hand-held equipment used to measure a relative afferent pupillary defect and to record pupil sizes. Four neutral density filters (0.3, 0.6, 0.9, 1.2 log units) are conveniently carried in a soft cloth carrying pouch. A bright light source (a Finhoff model illuminator is shown here) is ideal for stim... | Image |
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Aberrant Regeneration of the Right Pupil | Aberrant regeneration of the right pupil in a man with a large intracavernous sinus meningioma causing a pupil-involving, incomplete third cranial nerve palsy. His pupil is round when he gazes straight ahead (top). When he tries to rotate the eye medially, the pupil constricts, but a segment of the ... | Image |