Zusammenfassung
Klassischerweise betrachtet man die Pupillenbahn als einfachen Reflexbogen, bestehend aus den retinalen Ganglienzellen, mesenzephalen Interneuronen, N. oculomotorius und kurzen Ziliarnerven. Jedoch gibt es im Aufbau der afferenten Pupillenbahn einige Besonderheiten, die man bei der Beurteilung von typischen Krankheitsbildern mit Pupillenstörungen berücksichtigen muss und die bei der Topodiagnostik der Läsion sehr hilfreich sein können. Zusätzlich haben Untersuchungen von Patienten mit Läsionen der postgenikulären Sehbahn gezeigt, dass auch dabei Störungen der Pupillenlichtreaktion auftreten können. Die Pupillomotorik wird also nicht nur durch subkortikale Zentren gesteuert, sondern manche Komponenten der Pupillenreaktion sind auch durch die Sehrinde deutlich beeinflusst. Ziel dieses Beitrags ist es, verschiedene Begriffe und Befunde wie relativer afferenter Pupillendefekt und Hemihypokinesie der Pupille zu erklären.
Abstract
Classically, the pupillary pathway is considered as a simple reflex arc comprising retinal ganglion cells, midbrain interneurons, oculomotor nerve and short ciliary nerves. However, there are some specialties in the construction of the pupillary pathways that have to be kept in mind when dealing with diseases involving pupillary disorders. This may help to localise lesions. Additionally, studies in patients with lesions of the retrogeniculate pathways have shown that pupillary disorders are possible even with lesions not involving the classical reflex arc. The pupil is therefore not only controlled subcortically, some components are influenced by the visual cortex. The aim of this article is to clarify various findings and terms such as relative afferent pupillary defect and pupillary hemihypokinesia.
Schlüsselwörter
Pupille - homonyme Hemianopsie - Tractus opticus - Sehbahn - Pupillenperimetrie - relativer afferenter Pupillendefekt
Key words
pupil - homonymous hemianopia - optic tract - visual pathways - pupil perimetry - relative afferent pupillary defect
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Dr. Karolína Skorkovská
Augenklinik, Universitätsklinikum Tübingen
Schleichstr. 12
72076 Tübingen
Phone: ++ 49/70 71/2 98 73 16
Fax: ++ 49/70 71/29 53 61
Email: skorka@centrum.cz
