1. Opthalmoplagia opthalmoparesis

2. Eye movement Motor coordination Motor pathway cerebellum basal ganglia
vestibular system
Paralysis nystagmus
opthalmoparesis

3. eye movement(motor) pathway
Supranuclear
brainstem Internuclear
Nuclear
Craineal nerve
NMJ
muscle

5. Conjugate gaza palsy Horizontal: cortex &pontine
Unilateral restriction of voluntary gaze to one side .
Frontal damage: eye look to the lesion
epilepsy: eye look away
Pontine: abducent n or PPRF…impair look to site of lesion, look away ,towered hemiplasia

6. Vertical gaze palsy
Up –gaze palsy:pretectal lesion with damage to post comissure
Pretectal: parinaud syndrom: (paralysis of upward gaze,lid retraction,impaired converg,convergence retraction nystagmus,light near dissosiation)
Causes: tumer,hydrocephalus 3rd v compress on PC, stroke of thalamic &midbrain ,MS,truma,wilson,syphlis ,TB,drug neuroliptic,barbiturate,tegretol)

7. Oculogyric crisis:
Defention:episodic, spasmodic,conjugate ocular deviation,up wared &lateral. Accompanied with mental changes, may associate with dystonia or other dyskinesia
Causes: encephalities lethargica, degenerative dis eg familial parkison, head truma,neurosyphlis,MS,ataxia telengictasia,drug:neuroleptic

8. Disconjucate eye movement

9. Internuclear pathology
INO:
Damage to the MLF between 3&6 nerve ,impair transmisstion of impulse to the ipsilateral medial rectus
Impair ipsilateral adduction, abduction nystagmus
No visual symptoms,other diplopia
Nystagmus cause not clear but may adaptive

10. INO
Causes: MS,brainstem infarct,truma,

11. The one and half syndrome
Impaired congucate gaze to one side & impair adduction to the other side
PPRF or abducent nucleus + MLF

12. Nuclear ,nerve control Double vision
Brain stem contain the lower motor control of the eye movement
3rd supply all except:
4th SO, 6th LR

13. Nuclear (brain stem) Long tract signs Crossed phenomena Causes:
Tumor,MS,stroke

14. cranial nerve pathology
ocular neuropathy :
Compressive :localization acoording to stations
Non compressive: trauma, DM, vasculitis, demyelinating ( miller fisher syndrome), infection diphtheria

15. Ocular nerves pathway 3,4,6th nerve subarachnoid space cavernous sinus
Superior orbital fissure
orbit

16. At sub arachnoid Complete 3rd n palsy +_ other CN Causes:
Posterior communicating aneurysm 3rd,superior cerebellur 4th nerve
Tumor :meningeoma ,shwanoma
Trauma
Meningitis
SAH
Uncal herniation

17. At cavernous sinus Painful or painless if medially +_ 4,5,6
+ Horner syndrome
Causes:
Cavernous sinus thrombosis
Dural carotid cavernous sinus fistula
Carotid aneurysm lateral painless
Pituitary adenoma, apoplexy

18. At superior orbital fissure
3 +_,4,5.6 (no horner ,no maxillary nerve)
Causes:
Tolosa hunt syndrome

19. At the orbit Optic n visual loss, proptosis, swelling of lid ,chemosis
Causes:
Trauma ,tumor, cellulites

20. Imp note
Many lesion extend from cavernous sinus to orbital apex and vice viscera
Combined 3rd n & sympathetic denervation is pathognomonic for cavernous sinus lesion

21. neuromuscular
Myasthenia graves (flactuation)
botulism

22. muscle
Hereditary :mitochondrial
acquired
trauma
Thyroid
inflammatory