VISUAL SYSTEM VISUAL PATHWAYS

The visual pathway begins with the peripheral receptor organ (retina), which sends visually related impulses to the thalamus and on to the cerebral cortex. Color the heading Primary Visual Pathway, titles A through G, and related structures. Use distinctly different shades of the same color for B1 and B2. Color the heading Pupillary Light Reflex Pathway, titles H through M, and related structures. The optic nerve (B), formed by the axons of the ganglion cells of the retina (A), emerges from the posterior surface of the eyeball to enter the cranial cavity via the optic canal (recall Pate 6-2). The medial (nasal) fibers (B!) of the optic nerve cross in the optic chiasm (C; "crossing") to join the contralateral cp/cf raer (D).*The/arera/ {temporal) fibers (B2) continu through the chiasm uncrossed to enter the ipsilateral tract. Diverging around the hypothalamus, the fibers of the optic tract follow one of several courses. The primary visual pathway consists of the majority of optic tract fibers that synapse in the lateral geniculate body (E) of the thalamus. Fibers leaving the lateral geniculate body may follow different courses as they form the optic radiation (F) or geniculocalcarine tract to the visual (stri-ate) cortex (G), where they crate both banks of the calcarme fissure of the occipital lobe. Some of these geniculocalcarine fibers run anteriorly and inferiorly into the temporal lobe to loop posteriorly (Meyer's loop, F1), con-tinuing to the calcarine fissure. Meyer's loop carnes visual impulses from the upper and outer part of the visual field. Fibers associated with the pupillary light reflex pathway leave the optic tract as pretectal afferents (H). These enter the pretectal nucleus (H1), located between the rostral border of the mesencephalon and the caudal border of the epithalamus (not shown; see Pate 5-43). Pretectal ejfer-ents (H2) also pass via the posterior commissure (I) to interneurons (J) of the contralateral pretectal nucleus. The axons of these interneurons project anteriorly to the nucleus of Edinger Westphal (K; recall Pate 6-4). From this site, pregangiionic fibers (K1) accompany the oculomotor (III) nerve (not shown) to the orbital cavity and synapse in the ciliary ganglion (L; a motor ganglion associated with the
the purest sense, the nerve-chiasm-tract complex externalized tract of the brain.

parasympathetic divisin of the visceral nervous system). Postganglionic fibers (L1) leave the ciliary ganglion to innervate the ciliary muse le (P) of the ciliary body as well as the constrictor muscle of the iris (constrictor pupillae, M). By this pupillary light reflex pathway, the eye can constrict the pupil in response to bright light. By virtue of the fibers crossing in the posterior commissure, a light reflex initiated in one eye will genrate a bilateral response (consensual reflex). Pupillary dilatation in response to dim light, distant visin, anger, or fear is in-duced by sympathetic fibers (pathway not shown; see Pate 8-4). Color the heading Accommodation Reflex Pathway, titles N, O, and P, and related structures. The affer-ent limb of this reflex (F) has been colored and should be reviewed. Color the heading Visual Start-le/Tracking Reflex Pathway, titles Q and Q1, and related fibers. The accommodation reflex, involving flattening or round-ing of the lens in association with distant or near visin, respectively, includes primary visual (optic radiation) fibers as the afferent (input) limb of the reflex, unlike the pupillary light reflex, which oceurs independent of the cortex. Corticocollicular (N) and corticopretectal (not shown) fibers project anteriorly from rea 19 of the visual cortex to the superior colliculus (O), pretectal nuclei, or both. In association with mltiple synapses among several groups of interneurons there, impulses are conducted to the nucleus of Edinger Westphal and beyond, in a course similar to that of the efferent part (limb) of the pupillary light reflex. The effector of this reflex is the ciliary muscle (P), the contraction of which induces rounding of the lens. In this manner, near visin is facilitated. Some optic tract-collicular fibers (Q) leave the optic tract to enter the superior colliculus directly. Col-liculogeniculate fibers (Q1) feed back upon incoming visual impulses. Additional collicular axons (not shown) project caudally through the brain stem and spinal cord, controlling eye and head movements associated with visual tracking of moving objeets (recall Pate 4-10). This pathway is at least partly responsible for visual startling and visual tracking reflexes.

entire optic is really an

*You will recall that the entire optic system develops as a projection of the diencephaion (Pate 3-7). Accordingly, in

LESIONS OF THE VISUAL PATHWAY

Disease of or injury to the visual pathway often produces rather specific complaints of visual defects. This pate deals with typical signs of visual abnormalities associated with interruption of impulse conduction in certain reas of the visual pathway. The circles on the left of the pate represent the visual field on the left side, and the circles on the right represent the right visual field. The visual field of each eye has both temporal (lateral) and nasal (medial) sectors; the nasal sector is projected onto the temporal portion of the retina of the eye, and the temporal sector is projected onto the nasal portion of the retina. The nasal sectors of both left and right visual fields overlap to produce binocular visin. Since a portion of each optic nerve crosses to the contralateral side at the chiasm, lesions posterior to the chiasm usually involve both fields of visin.

Color the headings Left and Right Visual Field/ Retina and titles A, A1, B, and B 1, using contrasting pastel colors for A and B and different shades of the same colors for the titles with exponents. Color the visual fields above each eye and the binocular visual field at the top center of the pate. Color the parts of the retina of each eye and the corresponding fibers of the optic nerve, chiasma, optic tract, and optic radiation. Color the headings Left Side and Right Side. Color the bar labeled C black, representing a lesin or defect. Then color the related pair of titles (Normal Vision and Anopsia) and the left and right visual fields (uppermost circles), which would de-velop after a lesin was placed at site C. Repeat with each of the portrayed defects (D through G), related titles and ames, and disturbed and normal visual fields, as indicated.
A specific defect of the visual pathway may result in pre-dictable unilateral or bilateral visual-field defects. In the case of a lesin

within the retina or optic nerve anterior to the optic chiasm, the resultant loss of a visual field is restricted to one eye. If the lesin is at the chiasm or along the optic radiation, the result is a partial loss of visual field in both eyes. If the lesin occurs at the visual cortex, the visual loss may range from visual aberrations in specific quadrants (quadrantic defects) to total blindness. Injury to the optic nerve (direct trauma, swelling in the optic sheath, interruption of blood supply, etc.), if complete, as shown at bar C, results in total blindness or anopsia (C; an-, "without"; opsia, "visin") in the affected eye. A partial defect of the optic nerve (bar D) interrupts the nasal retinal fibers on the affected side, resulting in a loss of visin in the temporal field of the same side {left temporal hemianopsia (D; hemi-, "half ') If a pituitary tumor compresses the optic chiasm (represented by bar E), bilateral nasal retinal components of the optic nerves are affected, resulting in bitemporal {heteronymous) hemianopsia (E; heteronymous, "of the opposite side"), in which the temporal fields of both eyes are affected or lost. Interruption of the optic tract or optic radiation on one side (represented by either bar F) causes homonymous hemianopsia (F; homonymous, "of the same side"), in which the visual field affected is the same for each eye. Lesions such as tumors may develop deep within the temporal lobe for some time without symptoms. Their eventual impingement on the optic radiation fibers making up Meyer'sioop (bar G; recall Pate 6-7) can be the first sign of temporal lobe disease. The characteristic loss is an upper outer-quadrantic defect, often called a "pie-in-the-sky defect" or homonymous superior quadranta-nopsia (G). The defects shown here are only a few examples of a broad range of visual defects that can occur in the visual system.

THE BLOOD INTERNALCAROTID SUPPLY TO ARTERIES

BRAIN:

The adult brain requires 750 milliliters (almost a quart) of oxygenated blood every minute to maintain normal activ-ity. Of the total amount of oxygen delivered to the body tissues by the arteries, 20 percent is consumed by the brain alone. Under normal conditions, cessation of blood flow to the brain for 5 to 10 seconds is suicient to cause tempo-rary changes in neuronal activity. Interruption of flow for 5 to 10 minutes can produce irreversible neuronal damage. Delivery of blood to the brain is accomplished by two pairs of arteries. In this pate, the origin, course, and distribution of one pairthe internal carotid arteries and their branches are illustrated in a schematic anterior view. A lateral view of the course of the internal carotid artery and its branches are also shown, in a drawing from a carotid arteriogram. Color titles A through K and the related vessels, receptors, and plaques in the central illustration and the circled magnifed portions of the bifurcation of the carotid arteries. Then color the vessels in the drawing of the carotid arteriogram at the lower left. Color title L and its representation as well. The largest systemic artery, the aorta (A), leaves the base of the heart in a sweeping arch to supply the entire body with oxygenated blood. The aortic arch lies anterior to the formation of the paired primary bronchi from the bifurcation of the trachea at the level of the fourth thoracic vertebra. To the right of the midline, the aortic arch gives off a large vessel, the brachiocephalic artery (B), which nins a short distance rostrally and laterally before dividing to form the more central right common carotid artery (C) and the more lateral subclavian artery (shown but not to be colored). The latter vessel will be considered in the next pate. The origin of the left common carotid artery (C1) is different from that on the right, as there is no left brachiocephalic artery. The left common carotid artery arises directly from the aorta, slightly to the left of the midline. The left subclavian artery also arises directly from the aorta immediately lateral to the left common carotid artery. The right and left common carotid arteries ascend in the neck, each lateral to the trachea, sharing a common sheath with the internal jugular vein and vagus nerve (not shown).

At the level of the laryngeal prominence ("Adam's apple") of the thyroid cartilage (C5 vertebral level), each common carotid artery divides into external (D) and internal carotid arteries (E). The external carotid arteries supply the facial regin and anterior neck and are not considered here. At the root of the internal carotid artery, a swelling or thickening in the arterial wall, called the carotid sinus (F), incorporates pressure receptors con-nected to the sinus nerve (a part of the glossopharyngeal nerve; recall Pate 6-21). These receptors are part of the afferent limb of the blood pressure-regulating cardiovascular reflex. The point of carotid bifurcation is of interest for another reason, for here atherosclerosis (athero, "gruel"; sclerosis, "hardening") frequently occurs. This disease process in-volves the formation of granular, lipid-containing, plate-like atheromatous plaques (G) in the inner layer of certain arteries. These plaques can build up in the internal carotid arteries to such an extent that they obstruct the blood supply to the brain (cerebrovascular disease). Cardiovascular surgeons can often remove these plaques from the carotid bifurcation by a technique known as endarterec-tomy, restoring the blood supply to the brain. The internal carotid artery enters the skull through the carotid foramen (L), passes upward and anteriorly through the petrous portion of the temporal bone (petrous part), ascends into and curves anteriorly through the large cavernous (venous) sinus (cavernous part), and turns upward into the middle cranial fossa (cranial part). Here, just caudal to the optic nerve, the cavernous part of the internal carotid artery sends off the ophthalmic artery (H), which enters the orbit along the optic nerve to supply the orbital structures, including the eyeball. The internal carotid gives off the posterior communicating (see Pate 9-3) and anterior choroidal arteries (not shown) and then divides into its major terminal branches, the anterior cerebral (I) and middle cerebral arteries (J). The anterior communicating artery (K) can be seen connecting the paired anterior cerebral arteries. In the next pate, the second major arterial (vertebral-basilar) system to the brain is considered.

BLOOD SUPPLY TO THE BRAIN: VERTEBRAL ARTERIES

The vertebral arteries represent another significant source of blood to the brain. This pate shows a lateral view of the vertebral-basilar arterial system as it ascends through the neck and enters the skull. Its relationship to the com-mon and internal carotid arteries is also seen. Illustrations drawn from vertebral-basilar arteriograms, in both lateral and anterior-posterior projections, are included. Color titles A through H and related structures in the upper illustration. Then color the vessels in the drawings of the lateral and anteroposterior views of the vertebral and basilar arteries and their largest branches. The vertebral artery (D) arises from the superior surface of the first part of the subclavian artery. You will recall from the previous pate that the right subclavian artery (C) is one of the branches of the brachiocephalic artery (B). The brachiocephalic artery arises directly from the arch of the aorta (A). The left subclavian artery (not shown) arises from the aortic arch just lateral to the origin of the left common carotid artery (not shown; see Pate 9-1). Each vertebral artery dives deep toward the lower cervical vertebrae, medial and posterior to the scalenus anterior muscle and lateral and posterior to the common carotid artery. It enters and ascends through the transverse foramina (in the transverse processes) of the upper six cervical vertebrae. After passing through the atlas, it bends sharply medial to approach the foramen magnum (H) and turns upward to pass through it. In its passage through the transverse foramina, the vertebral artery gives one or two branches to the spinal cord (not shown). As the vertebral artery enters the posterior fossa of the cranial cavity, it lies on the ventral lateral aspect of the medulla. In its rostral course along the brain stem, it gives off some important branches, which can be seen in Plates 9-3 and 9-6: anterior and posterior spinal arteries, medul-lary arteries, and the posterior inferior cerebellar arteries. The left and right vertebral arteries merge on the anterior aspect of the caudal pons to form the basilar artery (E). Branches of this artery can be seen in Plates 9-3, 9-6, and 9-7: anterior inferior cerebellar arteries, pontine arteries, and superior cerebellar arteries. The basilar artery termi-nates at the caudal midbrain by bifurcating into the posterior cerebral arteries (F). By way of the posterior com-municating arteries (G) from the first part of the posterior cerebral vessels, the vertebral-basilar system has access to the carotid system. Arteriograms of the cerebellar and spinal branches of the vertebral arteries are used to search for space-occupy-ing lesions associated with the posterior cranial fossae and cervical spinal cord, respectively. As these avascular masses form, they may distort the normal pattern of these vessels. Introduction of contrast mdium into the vertebral system is usually accomplished by injection into the subclavian artery or percutaneous (through the skin) ca-theterization through the femoral artery of the thigh.