1. OCEAN MEDICAL CENTER STROKE SERIES

2. AWARENESS OF VISUAL SEQUELLA OF STROKES

3. 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

5. Visual Deficits Post CVA to watch for 1.Field Loss or Visual Inattention 2.Diplopia or Binocular Deficits 3.Spatial Deficits 4.Dry eye caused by poor lid closure, partial CN7 or CN 5 Ophthalmic Branch loss 5.Inability to read or scan

6. RETINA STRUCTURE FUNCTION

7. RETINAL STRUCTURE

8. GANGLION CELS

9. THREE PARALLEL PATHWAYS

10. BASE OF BRAIN

11. AFFERENT PAHTWAY RETINO GENICULATE CALCARINE PATHWAY

12. RETINO GENICULO CALCARINE PATHWAY

13. OPTIC TRACTS AND LATERAL GENICULATE

14. GANGLION CELL INPUT TO LGN LAYERS

15. 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

16. OPTIC RADIATIONS

17. PRIMARY CORTEX – VISUAL ORGANIZATION

18. THREE PARALLEL PATHWAYS

20. PRIMARY CORTEX – VISUAL ORGANIZATION

22. Territories Supplied by the Cerebral Arteries

23. SHORT ASSOCIATION FIBERS

24. LONG ASSOCIATION FIBERS

31. AFFERENT PATHWAY EXTRA GENICULATE PATHWAY Magno cellular

32. EXTRA GENICULATE PAHTWAY

33. 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.

34. RETINO SUPERIOR COLLICULUS

35. SUPERIOR COLLICULUS FIBERS AND MOTOR FIBERS

36. AFFERENT PATHWAY RETINO HYPOTHALAMIC PATHWAY

37. AFFERENT PATHWAY PRE TECTAL PATHWAY

38. Visual Field Loss By Deficit Areas

43. Review

46. EFFERENT EYE MOVEMENT

47. 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

48. 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 DURING PROLOGED ROTATION AND DIRECT GAZE TOWARD THE ONCOMING VISUAL SCENE

49. 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.

50. SMOOTH PURSUITS

51. SACCADES

52. VESTIBULAR

53. VERGENCE EYE MOVEMENT

54. SUPRA AND INFRA NUCLEAR PATHWAYS

55. 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.

56. 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.

57. CN 3,4,6 IN PONTINE REGION

58. CN 3,4.6 TRACTS THROUGH BRAIN

59. EOM ACTIONS

60. Visual Deficits Post CVA to watch for 1.Field Loss or Visual Inattention 2.Diplopia or Binocular Deficits 3.Spatial Deficits 4.Dry eye caused by poor lid closure, partial CN7 or CN 5 Ophthalmic Branch loss 5.Inability to read or scan

61. NO MAS