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Central Visual Pathways April 12, 2010 1.

Understand the organization of the pathways by which light stimulus reaching the retina leads to the activation of the visual cortex for visual perception and discrimination. a. GENERAL i. Retina optic nerve optic chiasm (site of partial decussation) optic tract LGN (thalamus) optic radiations primary visual cortex (occipital lobe) b. RETINA i. Rods and cones sense different intensities of light (rods = dark, cones = light/color) ii. Fovea: center of highest visual actuity 1. Surrounded by the macula iii. Bipolar neurons = NEURON 1 iv. Ganglion neurons = NEURON 2 1. Axons collect at optic disc to form OPTIC NERVE 2. Optic disc = blind spot v. Visual fields 1. Halves: temporal and nasal a. Each is further divided into upper and lower 2. Therefore, visual fields have 4 QUADRANTS 3. Visual fields of both eyes overlap ONE BINOCULAR VISUAL FIELD vi. Retina is divided into 4 quadrants 1. *there is INVERSION and RIGHT-LEFT REVERSAL between visual fields and retinal quadrants

On the LEFT: - L Temporal visual field projects onto L nasal retinal fiber fiber DECUSSATES - L Nasal visual field projects onto L temporal retinal fiber NO DECUSSATION *L temporal fiber = L Nasal field *L nasal fiber = L Temporal field

On the RIGHT: - R Temporal visual field projects onto R nasal retinal fiber fiber DECUSSATES - R Nasal visual field projects onto R temporal retinal fiber NO DECUSSATION *R temporal fiber = R Nasal field *R nasal fiber = R Temporal field

(Neuron 3)

L = R halves of visual fields of both eyes (L Nasal field + R Temporal field) R = L halves of visual fields of both eyes (L Temporal



i. Optic nerve = Nasal and Temporal halves of each monocular field on its respective side (i.e. L optic nerve = L visual fields) ii. Optic chiasm = PARTIAL DECUSSATION 1. Nasal retinal fibers (containing Temporal visual fields) decussate iii. Optic tract = one component of each visual field 1. LEFT = right halves of visual fields AKA left halves of the retinae 2. RIGHT = left halves of visual fields AKA right halves of the retinae d. LATERAL GENICULATE NUCLEUS (BODY) i. Contain Neuron 3 of visual pathway ii. Receive fibers from the ipsilateral optic tract iii. Axons project to the cortex as the geniculocalcarine tract ( = optic radiations)

e. OPTIC RADIATIONS i. Axons of the tract pass for a short distance through the POSTERIOR LIMB of the internal capsule in its most posterior part behind the sensory/motor fibers ii. This is the RETROLENTIFORM part of the posterior limb (behind the lentiform nucleus) iii. Axons from the internal capsule spread out in the white matter: 1. Temporal lobe: loop of Meyer a. Corresponds to two upper visual field quadrants of each half of binocular field = two lower retinal quadrants 2. Parietal lobe: a. Corresponds to two lower visual field quadrants of each half of the binocular field = two upper retinal quadrants f. VISUAL CORTEX i. Primary visual cortex = receives optic radiations 1. Visual stimuli that reach each primary visual cortex come from the contralateral half of the binocular visual field 2. Cuneus = from parietal lobe 3. Lingual = from temporal lobe (loop of Meyer) ii. Visual association cortex = receive from primary visual cortex 1. Play role in centers for the accommodation reflex iii. Other association areas 1. Ventral pathway (what): goes to temporal lobe for object identification 2. Dorsal pathway (where): goes to multimodal association cortex to analyze motion and location of objects

2. Learn how different parts of the visual fields are retinotopically represented at specific levels of the pathways a.


LEFT OPTIC RADIATIONS R lower visual field L upper retinal quadrant R upper visual field L lower retinal quadrant

RIGHT OPTIC RADIATIONS L lower visual field R upper retinal quadrant L upper visual field R lower retinal quadrant

3. Know the terminology used in describing visual field deficits and understand how pathology at different levels of the pathways may produce characteristic visual field deficits in a patient. a. Anopsia: loss of vision in the entire visual field i. Occurs in all lesions ANTERIOR to the optic chiasm (will affect only the corresponding eye) b. Hemianopsia: loss of vision in one half of the two visual fields i. Bitemporal: loss of vision in the temporal fields of both eyes ii. Homonymous: relating to corresponding halves/quadrants of the two visual fields (e.g. left halves/upper quadrants of both visual fields) c. Quadrantanopsia: loss of vision in one quadrant of the visual field

Anopsia (optic neuritis; ischemic infarct) complete loss of vision in ipsilateral eye

Bitemporal hemianopsia (pituitary tumor) lesion affects temporal fields of both eyes (decussate in chiasm) Homonymous hemianopsia (tumors) RIGHT tract: affects LEFT halves of both VF LEFT tract: affects RIGHT halves of both VF

Homonymous superior quadrantanopsia (tumors, infarcts of MCA) RIGHT loop: upper quadrant of LEFT halves LEFT loop: upper quadrant of RIGHT halves Homonymous inferior quadrantanopsia R parietal: lower quadrant of LEFT halves L parietal: lower quadrant of RIGHT halves

4. Learn the anatomical basis for the light and accommodation reflexes and examples of abnormal reflexes a. LIGHT REFLEX i. Afferent limb: optic nerve (CN II) 1. Bypass LGN go to pretectal area (superior colliculus) synapse in pretectal nuclei (diencephalon-midbrain junction)

2. Pretectal nuclei axons project bilaterally (ipsilateral through periaqueductal gray and contralateral though posterior commissure) and end on Edinger-Westphal nucleus ii. Efferent limb: oculomotor nerve (CN III) 1. Projects bilaterally to ciliary ganglion synapse onto sphincter pupillae muscles to constrict pupil of BOTH EYES 2. Direct: constriction of pupil that is being flashed by the light source 3. Consensual: constriction of the pupil of the opposite eye iii. LESIONS 1. If located in LGN, optic radiations, or primary visual cortex reflex is NOT affected b. ACCOMMODATION REFLEX i. Three responses 1. Pupillary constriction 2. Adduction of the eyes convergence 3. Contraction of the smooth muscle of the ciliary body rounding of lens ii. Afferent limb: retinal ganglion cells/optic nerve iii. Association limb: LGN primary visual cortex accommodation center iv. Efferent limbs: accommodation center bilateral projections to 1. CN III motor nucleus medial recti muscles of both eyes 2. Edinger-Westphal nucleus ciliary ganglia constrictor pupillae and ciliary muscles c. ABNORMAL PUPILLARY REFLEXES Damage Right CN II Left CN II Right CN III Left CN III RIGHT Direct reflex Absent Present Absent Present LEFT Consensual Absent Present Present Absent LEFT Direct Present Absent Present Absent RIGHT Consensual Present Absent Absent Present