Download PDF
Neuroradiologie Scan 2014; 04(04): 305-323
DOI: 10.1055/s-0034-1377415
Fortbildung
© Georg Thieme Verlag KG Stuttgart · New York

Intrakranielle Ursachen der Ophthalmoplegie: die visuellen Reflexbahnen[1]

Intracranial causes of ophthalmoplegia: the visual reflex pathways
Seth T. Stalcup
,
August S. Tuan
,
John R. Hesselink
Further Information

Publication History

Publication Date:
30 September 2014 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Die Gewinnung visueller Informationen ist ein komplexer Prozess, der ein fein austariertes Zusammenspiel der Augenbewegungen voraussetzt. Auch die Hirnnerven II – VIII sind, zumindest partiell, am visuellen System beteiligt. Sie funktionieren jedoch nicht isoliert, sondern erhalten Signale zur Koordination der Augenbewegungen von verschiedenen übergeordneten kortikalen Zentren. Die kortikalen Reflexbahnen haben u. a. die Aufgabe, die Augenbewegungen bei der vertikalen und horizontalen Ausrichtung des Blickes als Antwort auf Signale aus dem vestibulären System mit dem Ziel zu kontrollieren, die Augen auf ein Objekt fokussiert zu halten, während sich der Kopf im Raum bewegt. Eine weitere Aufgabe ist die Kontrolle der koordinierten schnellen Augenbewegungen (Sakkaden) beim Einstellen des Blickes auf ein neues Objekt. Andere Reflexbahnen verbinden die am Sehprozess beteiligten Hirnnerven miteinander und ermöglichen so den konsensuellen Lidschlagreflex (Blinzeln) beider Augen, wenn die Hornhaut eines Auges gereizt wird, oder die gleichzeitige Verengung beider Pupillen, wenn Licht durch die Pupille eines Auges fällt. Eine Vielzahl intrakranieller Erkrankungen kann die Funktion der Hirnnerven und die visuellen Reflexbahnen stören, so z. B. benigne und maligne Neoplasmen, Infektionen, Traumata, Autoimmunkrankheiten, Gefäßanomalien, degenerative Erkrankungen und kongenitale erbliche Störungen. Diese Erkrankungen können sich in unendlich vielfältiger Weise manifestieren – sei es als Lähmung der äußeren Augenmuskeln, afferente Pupillenstörung oder okulosympathische Parese (Horner-Syndrom), sei es als internukleäre Ophthalmoplegie, dorsales Mittelhirnsyndrom (Parinaud-Syndrom) oder Verlust des Kornealreflexes. Die Kenntnis von Funktion und Anatomie der Hirnnerven und der visuellen Reflexbahnen einerseits, zusammen mit der Wahl der geeigneten magnetresonanztomografischen Pulssequenz andererseits, erlaubt dem Neurologen die Anordnung einer sinnvollen Bildgebung zur Darstellung des involvierten Hirnnervs bzw. der betroffenen visuellen Reflexbahn auf der Basis der Symptomatik des Patienten und spielt somit eine entscheidende Rolle für die Diagnosestellung und die Therapieplanung.

Abstract

The gathering of visual information is a complex process that relies on concerted movements of the eyes, and cranial nerves II – VIII are at least partially involved in the visual system. The cranial nerves do not function in isolation, however, and there are multiple higher-order cortical centers that have input into the cranial nerves to coordinate eye movement. Among the functions of the cortical reflex pathways are (a) controlling vertical and horizontal gaze in response to vestibular input to keep the eyes focused on an object as the head moves through space, and (b) controlling rapid, coordinated eye movement to a new visual target (saccades). There are also reflex pathways connecting the cranial nerves involved in vision that produce consensual blinking of the eyes in response to corneal stimulation of one eye and consensual pupillary constriction in response to light input on one pupil. A variety of intracranial pathologic conditions, including benign and malignant neoplasms, infection, trauma, autoimmune diseases, vascular anomalies, degenerative diseases, and inherited-congenital disorders, can disrupt the cranial nerves and visual reflex pathways. This disruption can manifest in myriad ways – for example, as extraocular muscle paresis, afferent pupillary defect, oculosympathetic paresis (Horner syndrome), internuclear ophthalmoplegia, dorsal midbrain (Parinaud) syndrome, or loss of the corneal reflex. Knowledge of the function and anatomy of the cranial nerves and visual reflex pathways, coupled with selection of the proper magnetic resonance pulse sequence, will allow the radiologist to order appropriate imaging of the involved cranial nerve or visual reflex pathway based on the patient’s symptoms and thereby play an essential role in establishing the diagnosis and planning appropriate therapy.

1 © 2013 The Radiological Society of North America. All rights reserved. Originally puplished in English in RadioGraphics 2013; 33: E153 – E169. Online published in 10.1148 /rg.335125142. Translated and reprinted with permission of RSNA. RSNA is not responsible for any inaccuracy or error arising from the translation from English to German.


 

  • Literatur

  • 1 Prasad S, Galetta SL. Anatomy and physiology of the afferent visual system. In: Kennard C, Leigh RJ, eds. Handbook of clinical neurology. Amsterdam, the Netherlands: Elsevier; 2011: 3-19
    Google Scholar
  • 2 Waxman SG. Brain nerves and pathways. In: Waxman SG, ed. Clinical neuroanatomy. 26th ed New York, NY: McGraw-Hill; 2010
    Google Scholar
  • 3 Wilhelm H. Disorders of the pupil. In: Kennard C, Leigh RJ, eds. Handbook of clinical neurology. Amsterdam, the Netherlands: Elsevier; 2011: 427-466
    Google Scholar
  • 4 Chou KL, Galetta SL, Liu GT et al. Acute ocular motor mononeuropathies: prospective study of the roles of neuroimaging and clinical assessment. J Neurol Sci 2004; 219: 35-39
    CrossrefPubMedGoogle Scholar
  • 5 Murchison AP, Gilbert ME, Savino PJ. Neuroimaging and acute ocular motor mononeuropathies: a prospective study. Arch Ophthalmol 2011; 129: 301-305
    CrossrefPubMedGoogle Scholar
  • 6 Sheth S, Branstetter 4th BF, Escott EJ. Appearance of normal brain nerves on steady-state free precession MR images. RadioGraphics 2009; 29: 1045-1055
    CrossrefGoogle Scholar
  • 7 Snell RS. Clinical neuroanatomy. 6th ed. Philadelphia, Pa: Lippincott; 2006
    Google Scholar
  • 8 Harnsberger HR. Brain nerves. In: Macdonald AJ, ed. Diagnostic and surgical imaging anatomy: brain, head and neck, spine. Salt Lake City, Utah: Amirsys; 2009: 174-254
    Google Scholar
  • 9 Rootman J, Stewart B, Goldberg RA. Orbital surgery: a conceptual approach. Philadelphia, Pa: Lippincott Williams & Wilkins; 1995
    Google Scholar
  • 10 Santillan A, Zink WE, Knopman J et al. Early endovascular management of oculomotor nerve palsy associated with posterior communicating artery aneurysms. Interv Neuroradiol 2010; 16: 17-21
    Google Scholar
  • 11 Sharma K, Kanaujia V, Lal H et al. Isolated oculomotor nerve palsy: an unusual presentation of temporal lobe tumor. Asian J Neurosurg 2010; 5: 70-72
    Google Scholar
  • 12 Aribandi M, Wilson NJ. CT and MR imaging features of intracerebral epidermoid: a rare lesion. Br J Radiol 2008; 81: e97-e99
    CrossrefGoogle Scholar
  • 13 Bhatti MT, Schiffman JS, Pass AF et al. Neuro-ophthalmologic complications and manifestations of upper and lower motor neuron facial paresis. Curr Neurol Neurosci Rep 2010; 10: 448-458
    CrossrefGoogle Scholar
  • 14 Fukushima J, Akao T, Kurkin S et al. The vestibular-related frontal cortex and its role in smooth-pursuit eye movements and vestibular-pursuit interactions. J Vestib Res 2006; 16: 1-22
    Google Scholar
  • 15 Kumar N, Cohen-Gadol AA, Wright RA et al. Superficial siderosis. Neurology 2006; 66: 1144-1152
    CrossrefGoogle Scholar
  • 16 Hsu WC, Loevner LA, Forman MS et al. Superficial siderosis of the CNS associated with multiple cavernous malformations. AJNR Am J Neuroradiol 1999; 20: 1245-1248
    Google Scholar
  • 17 Gelal FM, Kitis O, Calli C et al. Craniocervical artery dissection: diagnosis and follow-up with MR imaging and MR angiography. Med Sci Monit 2004; 10: MT109-MT116
    Google Scholar
  • 18 George A, Haydar AA, Adams WM. Imaging of Horner’s syndrome. Clin Radiol 2008; 63: 499-505
    CrossrefGoogle Scholar
  • 19 Sacco RL, Freddo L, Bello JA et al. Wallenberg’s lateral medullary syndrome: clinical-magnetic resonance imaging correlations. Arch Neurol 1993; 50: 609-614
    CrossrefPubMedGoogle Scholar
  • 20 Jeffery AR, Ellis FJ, Repka MX et al. Pediatric Horner syndrome. J AAPOS 1998; 2: 159-167
    CrossrefGoogle Scholar
  • 21 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
    CrossrefGoogle Scholar
  • 22 Lee JH, Lee HK, Lee DH et al. Neuroimaging strategies for three types of Horner syndrome with emphasis on anatomic location. AJR Am J Roentgenol 2007; 188: W74-W81
    CrossrefPubMedGoogle Scholar
  • 23 Danesh-MAuger HV, Savino P, Sergott R. The correlation of phenylephrine 1% with hydroxyamphetamine 1% in Horner’s syndrome. Br J Ophthalmol 2004; 88: 592-593
    CrossrefGoogle Scholar
  • 24 Fix JD. Neuroanatomy. 4th ed. Philadelphia, Pa: Lippincott; 2008
    Google Scholar
  • 25 Jacobs DA, Galetta SL. Neuro-ophthalmology for neuroradiologists. AJNR Am J Neuroradiol 2007; 28: 3-8
    Google Scholar
  • 26 Aziz TA, Holman RP. The Argyll Robertson pupil. Am J Med 2010; 123: 120-121
    CrossrefGoogle Scholar
  • 27 Thompson HS, Kardon RH. The Argyll Robertson pupil. J Neuroophthalmol 2006; 26: 134-138
    CrossrefPubMedGoogle Scholar
  • 28 Rucker JC. Normal and abnormal lid function. In: Kennard C, Leigh RJ, eds. Handbook of clinical neurology. Amsterdam, the Netherlands: Elsevier; 2011: 403-424
    Google Scholar
  • 29 Bronstein AM, Rudge P, Gresty MA et al. Abnormalities of horizontal gaze: clinical, oculographic and magnetic resonance imaging findings. II. Gaze palsy and internuclear ophthalmoplegia. . J Neurol Neurosurg Psychiatry 1990; 53: 200-207
    CrossrefGoogle Scholar
  • 30 Frohman EM, Zhang H, Kramer PD et al. MRI characteristics of the MLF in MS patients with chronic internuclear ophthalmoparesis. Neurology 2001; 57: 762-768
    CrossrefGoogle Scholar
  • 31 Keane JR. Internuclear ophthalmoplegia: unusual causes in 114 of 410 patients. Arch Neurol 2005; 62: 714-717
    CrossrefPubMedGoogle Scholar
  • 32 Pierrot-Deseilligny C. Nuclear, internuclear, and supranuclear ocular motor disorders. In: Kennard C, Leigh RJ, eds Handbook of clinical neurology. Amsterdam, the Netherlands: Elsevier; 2011: 319-331
    Google Scholar
  • 33 Chen CM, Lin SH. Wall-eyed bilateral internuclear ophthalmoplegia from lesions at different levels in the brainstem. J Neuroophthalmol 2007; 27: 9-15
    CrossrefGoogle Scholar
  • 34 de Seze J, Lucas C, Leclerc X et al. One-and-a-half syndrome in pontine infarcts: MRI correlates. Neuroradiology 1999; 41: 666-669
    CrossrefGoogle Scholar
  • 35 Lee AG, Brazis PW. Supranuclear disorders of gaze. In: Lee AG, Brazis PW, eds. Clinical pathways in neuro-ophthalmology: an evidence-based approach. 2nd ed New York, NY: Thieme; 2003: 311-336
    Article in Thieme ConnectGoogle Scholar
  • 36 Horn AKE, Leigh JR. The anatomy and physiology of the ocular motor system. In: Kennard C, Leigh RJ, eds. Handbook of clinical neurology. Amsterdam, the Netherlands: Elsevier; 2011: 21-69
    Google Scholar
  • 37 Kremmyda O, Glasauer S, Guerrasio L et al. Effects of unilateral midbrain lesions on gaze (eye and head) movements. Ann N Y Acad Sci 2011; 1233: 71-77
    CrossrefGoogle Scholar
  • 38 Strupp M, Hüfner K, Sandmann R et al. Central oculomotor disturbances and nystagmus: a window into the brainstem and cerebellum. Dtsch Arztebl Int 2011; 108: 197-204
    Google Scholar
  • 39 Boeve BF. Progressive supranuclear palsy. Parkinsonism Relat Disord 2012; 18: 192-S194
    Google Scholar
  • 40 Cavalleri F, Berardi A, Burlina AB et al. Diffusion-weighted MRI of maple syrup urine disease encephalopathy. Neuroradiology 2002; 44: 499-502
    CrossrefGoogle Scholar