Lesions of the optic tracts

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Questions and Answers

Which of the following structures is NOT part of the central nervous system component of the optic pathway?

  • Optic nerve (correct)
  • Optic chiasm
  • Striate cortex
  • Lateral geniculate bodies

Nerve fibers from which portion of the retina cross the midline at the optic chiasm?

  • Temporal
  • Nasal (correct)
  • Inferior
  • Superior

Where do nerve fibers from the temporal half of the retina project?

  • They terminate in the optic chiasm
  • To the contralateral side of the brain
  • To both sides of the brain
  • To the ipsilateral side of the brain (correct)

After the crossover in the optic chiasm, where is visual information from the right visual field primarily conveyed?

<p>Left side of the brain (C)</p> Signup and view all the answers

Where do light rays from the temporal half of the visual field fall on the retina?

<p>Nasal half (A)</p> Signup and view all the answers

The normal visual field of a single eye spans approximately how many degrees?

<p>130 to 145 degrees (A)</p> Signup and view all the answers

A lesion in the right optic nerve anterior to the optic chiasm will likely result in which visual field defect?

<p>Ipsilateral vision loss (B)</p> Signup and view all the answers

Damage to what location of the visual pathway would cause a bitemporal hemianopia?

<p>Optic chiasm (C)</p> Signup and view all the answers

What term describes an area of partial alteration in the visual field with diminished or degenerated visual acuity?

<p>Scotoma (A)</p> Signup and view all the answers

What is the MOST likely visual field defect if a patient injures Meyer's loop on the RIGHT side?

<p>Left superior quadrantanopia (D)</p> Signup and view all the answers

According to visual field rules, if a patient is found to have visual field defects in both eyes, what does this suggest?

<p>The lesion is located at the optic chiasm or retrochiasmal pathways. (A)</p> Signup and view all the answers

A patient presents with a dark spot in the center of their field of vision. How is this type of scotoma classified?

<p>Central (D)</p> Signup and view all the answers

What is indicated by a cecocentral scotoma?

<p>Involvement of the optic disc and papillomacular fibers. (D)</p> Signup and view all the answers

After damage to the optic radiations, what type of visual field defect can be expected?

<p>Homonymous hemianopia (B)</p> Signup and view all the answers

What is the definition of Primary visual areas?

<p>Areas in occipital lobes of the cerebral cortex (C)</p> Signup and view all the answers

Which condition is most associated with nerve fiber bundle defects that can cause an arcuate scotoma on visual field testing??

<p>Glaucoma (B)</p> Signup and view all the answers

If a patient has a lesion posterior to the optic chiasm that affects the inferior fibers, what type of visual field defect would MOST likely result?

<p>Superior quadrantanopia (A)</p> Signup and view all the answers

Which of the following visual field defects is MOST indicative of a lesion affecting the optic chiasm?

<p>Bitemporal hemianopia (B)</p> Signup and view all the answers

In homonymous hemianopia with macular sparing, which area of the brain is most likely affected?

<p>Occipital lobe (A)</p> Signup and view all the answers

A patient exhibits a visual field defect characterized by a loss of vision in the same half of the visual field in both eyes. What is the MOST appropriate term for this condition?

<p>Homonymous hemianopia (A)</p> Signup and view all the answers

What is the MOST likely cause of visual field defects that respect the vertical midline?

<p>Lesions <em>posterior</em> to the optic chiasm (A)</p> Signup and view all the answers

Superior retinal fibers remain so along all the system

<p>True (B)</p> Signup and view all the answers

Inferior retinal nerve fibers cross at the optic chiasm

<p>False (B)</p> Signup and view all the answers

A 20-year-old female presents with progressive visual loss, menstrual irregularities, and galactorrhea. What is the most likely location of the lesion?

<p>Optic chiasm (B)</p> Signup and view all the answers

A 54-year-old male develops acalculia, left-to-right disorientation, dysgraphia, and finger agnosia. Where is the most suitable place for a lesion?

<p>RT parietal lobe (A)</p> Signup and view all the answers

A 76-year-old female experiences a sudden headache and vision loss in the left eye. Visual acuity is 20/20 OD & OS. The visual fields performed are as shown in the image on the slide. Where is the lesion most likely located?

<p>Right occipital lobe (A)</p> Signup and view all the answers

Which of the following is typically associated with lesions within the optic nerve?

<p>Ipsilateral visual field defect (B)</p> Signup and view all the answers

Which of the following is typically associated with lesions within the chiasmal or retrochiasmal lesions?

<p>Visual field defect in both eyes (A)</p> Signup and view all the answers

An 8-year-old girl with 20/200 vision displays bilateral cecocentral scotomas on the visual field test. Where is the lesion located?

<p>Optic nerves (A)</p> Signup and view all the answers

A 54 yr. Old male is found to have increased intraocular pressure. Which visual filed is compatible with the diagnosis of glaucoma?

<p>nerve fiber loss (C)</p> Signup and view all the answers

A patient has a complete lesion of the right optic tract close to the LGN. What is the expected visual field defect?

<p>Left Homonymous Hemianopia (C)</p> Signup and view all the answers

A patient reports the sudden loss of vision in all but their right eye's nasal field. Where is the lesion?

<p>Left Optic Tract (D)</p> Signup and view all the answers

Damage to what location of the visual pathway would cause a left homonymous hemianopia with macular sparing?

<p>Occipital lobe (D)</p> Signup and view all the answers

What is the most common initial visual field defect associated with glaucoma?

<p>Arcuate Scotoma (B)</p> Signup and view all the answers

Which vascular structure, when infarcted, would most likely cause homonymous hemianopia with macular sparing?

<p>Posterior cerebral artery (B)</p> Signup and view all the answers

What is the most common defect from a pituitary tumor?

<p>Bitemporal hemianopsia (C)</p> Signup and view all the answers

Which of the following best describes the concept of 'macular sparing' in visual field defects?

<p>Preservation of central vision despite peripheral field loss (B)</p> Signup and view all the answers

A patient with a lesion affecting the optic radiations would MOST likely exhibit which visual field deficit?

<p>Homonymous hemianopia (C)</p> Signup and view all the answers

Which of the following symptoms would MOST suggest involvement of the parietal lobe in a patient with a visual field defect?

<p>Spatial disorientation (B)</p> Signup and view all the answers

Lesions of the optic nerve results in which of the following visual defects

<p>Ipsilateral visual defects (C)</p> Signup and view all the answers

Flashcards

Optic Pathway function

The optic pathway describes the journey of nerve impulses from the retina to the occipital cortex, enabling sight or visual perception.

Components of Optic Pathway

The retina, optic nerve, chiasm & tracts, lateral geniculate bodies, optic radiation, and visual (striate) cortex make up the optic pathway.

Nasal Retinal Fiber Crossing

Nerve fibers from the nasal half of each retina cross the midline at the optic chiasm and enter the optic tract on the opposite side.

Temporal Retinal Fibers

Nerve fibers from the temporal half of the retina do not cross at the optic chiasm, remaining on the same side.

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Visual Field to Retina (Temporal)

Light rays from the temporal half of the visual field fall on the nasal half of the retina.

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Visual Field to Retina (Nasal)

Light rays from the nasal half of the visual field fall on the temporal half of the retina

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Visual Field Brain Processing

After crossing at the chiasm, visual information from the right half of the visual field is conveyed to the left side of the brain, and vice versa.

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Scotoma Defined

A scotoma is an area of partial alteration in the visual field, characterized by diminished or degenerated visual acuity surrounded by a normal field.

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Central Scotoma

A dark spot in the center of the visual field while peripheral vision remains normal.

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Cecocentral Scotoma

Involves both the optic disc area (blind spot) and the papillomacular fibers.

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Paracentral Scotoma

Refers to a dark spot that occurs near, but not directly in, the central visual field.

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Retinal Fiber Rule

Superior retinal fibers remain superior, and inferior retinal fibers remain inferior throughout the visual system.

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Optic Nerve Lesion Rule

Optic nerve lesions produce ipsilateral visual field defects.

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Chiasmal/Retrochiasmal Lesion Rule

Chiasmal or retrochiasmal lesions typically produce visual field defects in both eyes.

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Retrochiasmal Lesion Effect

Retrochiasmal lesions induce homonymous visual field defects, affecting the same side of the visual field in both eyes.

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Temporal Lobe Lesion Impact

Temporal lobe lesions commonly cause superior quadrantanopia (‘pie in the sky’ defect).

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Occipital Lobe Impact

Occipital lobe lesions induce homonymous, congruent visual field defects.

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Glaucoma

Increased intraocular pressure may result in glaucoma.

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Study Notes

Overview of the Visual System

  • The optic pathway facilitates sight and visual perception.
  • This pathway transmits nerve impulses from the retina to the occipital cortex.
  • Key components include the retina, optic nerve, optic chiasm, optic tracts, lateral geniculate bodies, optic radiation, and the visual (striate) cortex.
  • All the structures are considered part of the central nervous system

Retinal Nerve Fiber Layer

  • Axons from the papillomacular bundle are within this layer

Anatomy of Nerve Fibers

  • Nerve fibers from the nasal half of each retina cross the midline.
  • They then enter the optic tract on the opposite side.
  • Nerve fibers from the temporal half of the retina stay on the same side.
  • Does not cross the midline

Visual Fields and Light

  • Light rays from the temporal half of the visual field project to the nasal half of the retina.
  • Light rays from the nasal half of the visual field project to the temporal half of the retina.
  • After crossing at the chiasm, information from the right visual field goes to the left side of the brain.
  • Information from the left visual field goes to the right side of the brain

Visual Field Rules

  • Superior retina fibers remain superior throughout the visual system
  • Inferior retina fibers remain inferior throughout the visual system
  • Optic nerve lesions cause ipsilateral visual field defects.
  • Chiasmal or retrochiasmal lesions result in visual field defects in both eyes.

Scotomas

  • Scotoma is an area of partial alteration in the visual field, with diminished acuity, surrounded by normal vision.
  • Central scotoma is a dark spot in the center of vision, with the remaining field normal.
  • Cecocentral scotoma involves the optic disc (blind spot) and papillomacular fibers.
  • Paracentral scotoma occurs near, but not in, the central visual field.

Homonymous Hemianopsia:

  • Optic Tract: 3% Incidence
  • LG Body: 1% Incidence
  • Temporal Lobe: 24% Incidence, 9:1 Tumor/Vascular Ratio
  • Parietal Lobe: 33% Incidence, 1:1 Tumor/Vascular Ratio
  • Occipital Lobe: 39% Incidence, 1:3 Tumor/Vascular Ratio

Occipital Lobe Lesions

  • Lesions induce homonymous congruent visual defects.
  • Can cause congruous homonymous hemianopsia.
  • Can cause homonymous hemianopic scotomas.
  • Can cause macular sparing, temporal crescent syndrome, cortical blindness, and homonymous altitudinal defects.

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