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Voluntary conjugated gaze (LESIONS (Right abducens nerve (it can abduct to…
Voluntary conjugated gaze
e.g. to the right: right abduction
:explode: 1. left cerebral cortex eye field - Area 8
pons: right paramedian pontine reticular formation - PPRF (center for IPSILATERAL horizontal gaze)
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medial longitudinal fasciculus
Decussates
left adduction
oculomotor
nucleus
Left medial rectus muscle :explode:
adjacent to the 3.
abducens nucleus
:explode: right medial rectus muscle
contralateral action
LESIONS
Right abducens nerve
can't look right
it can abduct to the midpoint
IO, SR: accesory function - weak abductors of the eye
MLF - left
Very common site of demyelination - MS (INO)
impaired adduction in both eyes during voluntary conjugated gaze
L eye cannot look right
diplopia in horizontal gaze
convergence intact
near response doesn't need MLF
in contrast, III nerve
:red_cross: convergence, conjugated gaze + dilated pupil
Nystagmus on the R (normal) eye
cortex tries to pull that eye in line with the affected one
Abducens
nucleus
- right
neither eye can look the lesion side
IPSILATERAL facial paralysis: VII nerve hooks over the right abducens nucleus. Analogous to bell's palsy
frontal eye field e.g. right
neither eye can look right
slow drift to the left
proximity to the corticobulbar fibers
R lower face weakness