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An Approach to Pupillary Disorders
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Sarosh M. Katrak, Azad M. Irani
The preganglionic second-order neurons lie at the base of the neck and ascends up to the superior cervical ganglia located at the level of bifurcation of the common carotid artery and the angle of the jaw. In a large series of HS, an etiological diagnosis was made in 44% of patients with a preganglionic lesion [6]. The most common etiology was malignant tumors of the apex of the lungs (Pancoast tumor) or metastasis from breast cancer. The Pancoast tumor may also involve the brachial plexus with pain in the shoulder and arm. Therefore, this tumor should be considered in any patient with a non-traumatic, new-onset HS and shoulder or arm pain, particularly in elderly males who are smokers. Direct trauma to the spinal cord during forceps delivery may produce a HS together with upper arm palsy (Klumpke palsy) [11].
Miscellaneous
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
The eye receives supply from both the parasympathetic and the sympathetic fibres (Figure 7.7). Parasympathetic supplyThe preganglionic fibres originate in the Edinger-Westphal nucleus in the brain stem and then pass in the third cranial nerve to the ciliary ganglion. The postganglionic fibres then enter the eye via the short ciliary nerve and innervate the ciliary muscles.Activation of the parasympathetic pathway constricts the pupil (miosis).Sympathetic supplyThis originates in the hypothalamus, passing through the midbrain (uncrossed) and lateral medulla and emerges from T1 (close proximity to the lung apex) and passes to the superior cervical ganglion via the dorsal roots. The superior cervical ganglion is located deep to the carotid sheath at the level of the second and third cervical vertebrae. From there, the fibres synapse and project cranially and innervate the eye either via the short ciliary nerve, long ciliary nerve or directly into the orbit. These will then innervate the radial fibres of the iris.Activation of the sympathetic pathway dilates the pupil (mydriasis).
The Pineal Gland and Melatonin
Published in George H. Gass, Harold M. Kaplan, Handbook of Endocrinology, 2020
Jerry Vriend, Nancy A.M. Alexiuk
There are many similarities between the effects of the pineal on the neuroendocrine-gonadal axis and the neuroendocrine-thyroid axis. The inhibitory effects of an active pineal gland, or of melatonin injections, on gonadal and thyroid axes occur simultaneously in the hamster under a variety of experimental conditions.389 These effects have a time course of 3 to 10 weeks depending on the experimental conditions. Pinealectomy prevents both the antithyroid and the antigonadal effects of light restriction (see above). Surgical removal of the superior cervical ganglia also prevents both the antithyroid and antigonadal effects of light restriction. Both the gonadal and thyroid axes respond similarly to melatonin administration. Because the antithyroid and antigonadal actions of an active pineal gland make use of the same neural pathways and occur simultaneously, they appear to be different aspects of a syndrome produced by melatonin at a single CNS site.389
Anterolateral approach for subaxial vertebral artery decompression in the treatment of rotational occlusion syndrome: results of a personal series and technical note
Published in Neurological Research, 2021
Sabino Luzzi, Cristian Gragnaniello, Alice Giotta Lucifero, Stefano Marasco, Yasmeen Elsawaf, Mattia Del Maestro, Samer K. Elbabaa, Renato Galzio
The sympathetic chain is formed by a set of cervical ganglia and small fibers, also referred as sympathetic trunk. Although the sympathetic chain has an anatomical variability [58], most commonly is formed by a superior, middle, and inferior ganglion, as well as a stellate and vertebral ganglions. Superior, middle, and inferior ganglion are located at the level of the third, fifth and seventh cervical vertebra, respectively, whereas stellate and vertebral ganglia are related to the seventh cervical or first thoracic vertebra. Non infrequently, inferior cervical and stellate ganglion are fused [58]. The course of the sympathetic chain is oblique upward and laterally, under the prevertebral fascia. Its major axis forms an angle with the midline ranging between 10 and 11.5 degrees, and the distance of the inferior and superior ganglion from the medial border of the longus colli muscle measures 12.4 mm and 17.2 mm, respectively, on average [59,60]. The superior cervical ganglion is located above the longus capitis muscle and, at the level of C4/C5 disc, the sympathetic trunk crosses the line between the longus colli and longus capitis muscle.
Low-dose Bevacizumab Decreases Ocular Hypotensive Effect of Angiotensin II in Sprague Dawley Rats
Published in Current Eye Research, 2021
J. Skrzypecki, K. Ciepiaszuk, M. Gawryś-Kopczyńska
SPRD rats (n = 64) were divided into eight groups. All animals were injected intraperitoneally with either bevacizumab (0.02 mg/kg in 0.3 ml 0.9% NaCl) (n = 32) or vehicle (0.3 ml 0.9% NaCl) (n = 32) 7 days before and 90 minutes before the measurements. The dose of bevacizumab (0.02 mg/kg) was chosen to match the amount of bevacizumab injected during intravitreal injection (0.02 mg/kg). Intraperitoneal route was selected over subcutaneous as the latter leads to lower bioavailability.16 Immediately following the second injection of bevacizumab or vehicle rats were anaesthetized with intraperitoneal injection of urethane (1.5 g/kg) and underwent unilateral superior sympathetic gangliectomy (n = 32) or sham procedure (n = 32). The procedure was accomplished 60 minutes before measurements. Side of the procedure was selected randomly. Skin on the neck was incised laterally to the trachea. Connective tissue was dissected and superior cervical ganglion was visualized superiorly to the division of the common carotid artery and dorsally to the internal carotid artery. Subsequently, superior cervical ganglion was excised. Sham procedure followed similar steps except for surgical removal of the superior cervical ganglion. Additionally, all rats were implanted with intravenous and intraarterial catheters as described previously.17 In order to facilitate continuous IOP measurements, 27 G needle connected to the BIOPAC (Biopac Systems, Goleta, CA) transducer was placed into the anterior chamber of the eye. IOP was measured at the side of sympathectomy or sham procedure.
Transient anisocoria after a traumatic cervical spinal cord injury: A case report
Published in The Journal of Spinal Cord Medicine, 2020
Paul Overdorf, Gary J. Farkas, Natasha Romanoski
The sympathetic innervation to the eye is from the superior cervical ganglion (Fig. 1). The superior cervical ganglion lies anterior to the transverse processes of the second and third cervical vertebra. Anterior to the ganglion lies the carotid sheath with the internal carotid artery, internal jugular vein, and vagus nerve, while the longus capitis muscle is found posterior to the ganglion. Postganglionic sympathetic fibers from the superior cervical ganglion are distributed onto the internal carotid artery and help to form the internal carotid nerve plexus, which ascends on the internal carotid artery into the carotid canal to enter the cranial cavity (Fig. 1).11 Once in the cranial cavity, postganglionic fibers from the internal carotid nerve plexus travel on the nasociliary nerve of the ophthalmic division of the trigeminal nerve, while other fibers continue from the internal carotid nerve plexus as the sympathetic root of the ciliary ganglion.12 The sympathetic root of the ciliary ganglion traverses the ciliary ganglion without synapsing (Fig. 1). These nerves then travel on the short ciliary nerves of the ciliary ganglion to the eye where they innervate the dilator pupillae muscle. Some of these postganglionic sympathetic fibers also travel on the long ciliary nerve, a nerve branch of the nasociliary nerve, to reach the eye (Fig. 1). Sympathetic activation of the dilator pupillae muscle dilates the pupil.11,12