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many patients who show these retinal changes, analogous lesions are found in the brain (necrotizing arteriolitis and microinfarcts) These are the Lat geniculate body changes that underlie hypertensive encephalopaLateral ventricle thy There may be associated congestive heart failure and kidney failure; the elevated blood pressure Optic radiation must, of course, be controlled rapidly, but too preOptic tract cipitous a drop can result in retinal hypoperfusion and blindness Calcarine area The ophthalmoscopic appearance of retinal hemorrhages is determined by the structural arChiasm rangements of the particular tissue in which they Optic occur In the super cial layer of the retina, they are nerve linear or ame-shaped ( splinter hemorrhages) Temporal horn (Meyer s loop) because of their con nement by the horizontally Temporal detour coursing nerve bers in that layer These hemorFigure 13-3 The geniculocalcarine projection, showing the detour of lower bers around the rhages usually overlie and obscure the retinal vestemporal horn Note that a very small proportion of the pathway traverses the parietal lobe sels Round or oval ( dot-and-blot ) hemorrhages lie behind the vessels, in the outer plexiform layer of the retina (synaptic layer between bipolar cells and nuclei of and in blond individuals, and the prominence of the lamina cribrosa rods and cones Fig 13-1); in this layer, blood accumulates in the (a sieve-like structure in the central and nasal part of the disc form of a cylinder between vertically oriented nerve bers and through which run the fascicles of unmyelinated axons of the retinal appears round or oval when viewed end-on with the ophthalmoganglion cells) differs from one individual to another The absence scope Rupture of arterioles on the inner surface of the retina as of receptive elements in the optic disc, or papilla, accounts for the occurs with ruptured intracranial saccular aneurysms, arteriovenous normal blind spot The ganglion-cell axons normally acquire their malformations, and other conditions causing sudden severe elevamyelin sheaths after penetration of the lamina cribrosa, but they tion of intracranial pressure permits the accumulation of a sometimes do so in their intraretinal course, as they approach the sharply outlined lake of blood between the internal limiting memdisc These myelinated bers adjacent to the disc appear as white patches with ne-feathered edges and are a normal variant, not to be confused with exudates Nasal half of Temporal half of In evaluating changes in the retinal vessels, one must rememleft retina right retina ber that these are arterioles and not arteries Since the walls of retinal arterioles are transparent, what is seen with the ophthalmoscope is the column of blood within them The central light streak of many normal arterioles is thought to represent the re ection of light from the ophthalmoscope as it strikes the interface of the column of blood and the concave vascular wall In arteriolosclerosis (usually coexistent with hypertension), the lumina of the vessels are segmentally narrowed because of brous tissue replacement of the media and thickening of the basement membrane Straightening of the arterioles and arteriolar-venous compression are other signs of hypertension and arteriolosclerosis In this cirRight lateral cumstance the vein is compressed by the thickened arteriole within geniculate nucleus the adventitial envelope shared by both vessels at the site of crossing; this compression may rarely lead to occlusion of branches of the retinal veins Progressive arteriolar disease, to the point of occlusion of the lumen, results in a narrow, white ( silver-wire ) vessel with no visible blood column This change is associated most often with severe hypertension but may follow other types of Visual area occlusion of the central retinal artery or its branches (see descripof right tions and retinal illustrations further on) Sheathing of the venules, hemisphere probably representing focal leakage of cells from the vessels, is reportedly observed in up to 25 percent of patients with multiple sclerosis, but we have only rarely been able to detect it Similar alterations are also seen in leukemia, malignant hypertension, sarcoid, Behcet disease, and other forms of vasculitis In malignant hypertension there are, in addition to swelling Figure 13-4 Diagrammatic depiction of the retinal projections, showing of the optic nerve head and the retinal arteriolar changes noted the disproportionately large representation of the macula in the lateral geabove, a number of extravascular lesions: the so-called soft exuniculate nucleus and visual (striate) cortex (Redrawn by permission from dates or cotton-wool patches, sharply marginated and glistening Barr ML, Kiernan J: The Human Nervous System, 4th ed Philadelphia, hard exudates, retinal hemorrhages, and edema of the disc In Lippincott, 1983). using barcode in excel 2010 Easily generate Code 128 barcodes in Excel | Adam Dimech's ...
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