
okkulomottar naadi

moonnaamathe craniel naadi, craniel naadi III, allengil sii. enn. III ennum ariyappedunna okkulomottar naadi, mikacha bhramanapathathile villaliloode bhramanapathathilekku praveshikkukayum kanninte mikka chalanangalum praapthamaakkukayum kanpola uyarthukayum cheiyunna extraocular peshikale ulavaakkukayum cheiyunna oru craniel naadiyaan. pupillary kanstrakshanum aavasavum (vaayanayilennapole aduthulla vasthukkalil shradha kendreekarikkaanulla kazhivu) prapthamaakkunna aantharika netra peshikale nadeevalkkarikkunna naarukalum naadi adangiyirikkunnu. bhroonathinte madhya masthishkathinte basel plettil ninnaan okkulomottar naadi uruthirinjathu. thalayotiyile njarambukal IV, vi ennivayum kanninte chalanatthinte niyanthranatthil pankedukkunnu.
ghadana.
midbrainile suuppar kolikyulasinte thalatthil moonnaamathe naadi nucleusil ninnaan okkulomottar naadi uthbhavikkunnath. moonnaamathe naadi nucleus cerebral akvidakttilekkulla ventral, pree-akvidakttal gray maattaril sthithicheyyunnu. cerebral akvidakttinte iruvashathum vashathayi sthithi cheiyunna moonnaamathe rund naadi nucleusukalil ninnulla naarukal chuvanna nucleusiloode kadannupokunnu. chuvanna nucleus naarukalil ninnu substaanshya nigrayiloode kadannupokukayum okkulomottar salkkasil (interpedencular fosayude paarshwabhitthil oru kuzhal) brainsteminte padaarthatthil ninnu purathuvarikayum cheiyunnu.
brainstemil ninnu purathuvarumbol, naadi piya mettarinte oru aavaranathil nikshepikkukayum arachnoidil ninnu deerghamaayi moodukayum cheiyunnu. ithu mukalilulla cerebellarinum (thaazhe) pinbhaagathe cerebral damanikalkkum (mukalil) idayiloode kadannupokunnu, thudarnnu tentorium cerebelly swathanthravum attaachucheythathumaaya athirthikalkkidayil kadannupokunna dura mettar munbhaagathum pinbhaagathe clinoid prakriyayude paarshwabhaagatthum thulachukayarunnu.
ithu caverness sainasine kadannupokunnu, mattu bhramana naadikalkk mukalil, athinte kozhsil sahanubhooti naadeevyavasthayude caverness plexasil ninnu onno rando philamentukalum trigiminal nadiyude netra vibhajanathil ninnu ashayavinimayam nadathunna shaakhayum sweekarikkunnu. mikacha bhramanapathathile villaliloode okkulomottar naadi bhramanapathathilekku praveshikkumbol athu oru uyarnnathum thaazhnnathumaaya shaakhayaayi vibhajikkunnu.
unnatha shaakha.
okkulomottar nadiyude "unnatha shaakha" allengil "unnatha vibhajanam", cheruthaakumbol, opttik naadiyiloode madhyathiloode kadannupokunnu. ithu mikacha rectus, levettar palpebray superioris enniva nalkunnu.
thaazhnna shaakha.
okkulomottar nadiyude "thaazhnna shaakha" allengil "thaazhnna vibhajanam", valuthayi, moonnu shaakhakalaayi vibhajikkunnu.
eee shaakhakalellaam peshikalude purambhaagathu praveshikkunna thaazhnna charivilekkulla naadi ozhike avayude netra uparithalathil praveshikkunnu.
nucleus.
messencephaloninte (midbrain) munvashath ninnaan okkulomottar naadi (sii. enn. aii. aii. aii) undaakunnath. okkulomottar nadic rund newkliyukalundu
sahaanubhoothiyulla postganglionic naarukalum guhayude sainasinte mathilile aantharika caroted damaniyile plexasil ninnulla nadiyumaayi cherukayum naadiyiloode vitharanam cheyyukayum cheiyunnu, udha.jii., superior tarsal (mueller) peshiyude minusamarnna peshiyilekku.
pravartthanam.
levettar palpebra superioris, superior rectus, medial rectus, inferior rectus, infierir charivu peshikal ennivayude asthikooda peshikale nadeevalkkarikkunna gse tharam axonukal, general soomatik epharant enniva okkulomottar naadi ulppedunnu. (uyarnna charivullathum laattaral rectus ozhikeyulla ellah baahya peshikaleyum ithu ulavaakkunnu.)
siliyari ganglioninu preganglionic parasympathetics nalkunna general visaral epharant, jii. vii. iii. tharatthilulla aaksonukalum naadi ulppedunnu. siliyari gaangliyon postganglionic naarukal hraswa siliyari naadiyiloode airisinteyum siliyari peshikaludeyum kanstraktar pupillayilekku kadannupokunnu.
klinikkal praadhaanyam.
rogam.
okkulomottar nadiyude pakshaaghaatham, i.iii.okkulomottar naadi palsy, thaazhepparayunna kaaranangalal undaakaam
pramehamullavarum 50 vayassinu mukalilullavarumaaya aalukalil, classical ardhathil, pupillary reflexinte ozhivaakkaliloodeyaanu (allengil samrakshanam) oru okkulomottar naadi palsy sambhavikkunnath. okkulomottar nadiyile naadi naarukalude shareeraghadana krameekaranam moolamaanu ithu undaakunnathenn karuthappedunnu; pupillary pravartthanatthe niyanthrikkunna naarukal upariplavavum pramehatthinte saadhaarana ischemic parikkukalil ninnu rakshappedunnathumaanu. neremarichu, okkulomottar nadiyude kamprashanilekku nayikkunna oru aneurism upariplavamaaya naarukale baadikkukayum pupillary reflex nashtappedunnathinoppam moonnaamathe naadi palsiyaayi prathyakshappedukayum cheiyunnu (vaasthavathil, eee moonnaamathe naadi kandethal oru anyoorisathe prathinideekarikkunnathaayi kanakkaakkappedunnu-mattuvidhathil theliyikkunnathuvare-athu anweshikkanam).
parisodhana.
kanninte peshikal.
thalayotiyile njarambukal III, IV, vi enniva saadhaaranayaayi thalayotiyile naadi parisodhanayude bhaagamaayi orumichu parishodhikkunnu. rogiyude thala nischalamaayi pidikkaanum rogiyude munnil oru valia "echu" chuttikkarangunna viralo penlito maathram annukal kondu pinthudaraan examiner saadhaaranayaayi rogiyodu nirddeshikkunnu. kanninte chalanavum kanbolakalum nireekshikkunnathiloode, exatraocular peshikal, levettar palpebre superioris peshi, thalayotiyile njarambukal III, IV, vi ennivayekkurichu kooduthal vivarangal nedaan examinerinu kazhiyum. eathenkilum kanninte peshikalude pravartthanam nashtappedunnathu nethrarogathinu kaaranamaakunnu.
okkulomottar naadi mikka netra peshikaleyum niyanthrikkunnathinaal, athinu kedupaadukal kandethunnathu eluppamaayirikkum. eee nadic kedupaadukal, okkulomottar naadi palsy ennu vilikkunnu, ithu baadhicha kanninte sthaanam (paarshwabhaagathu, nottam thaazhekku vyathichalikkunnath) kaaranam athinte "thaazhekkum puratthekkum" lakshanangalal ariyappedunnu.
pupillary reflex.
okkulomottar naadi annukalude kuthaneyum kanninte lensinte katiyum niyanthrikkunnu. ithu rund pradhana vazhikaliloode pareekshikkam. oru vyakthiyude mukhathekku viral neekkiyukondu avarude vidyaarthikalkku edanilamundaakkanam.
oru kannilekku prakasham parathunnathu mattoru kanninte thulyamaaya churukkatthinu kaaranamakum. opttik njarambukalil ninnulla naarukal opttik chiyaasmiloode kadannupokunnu, chila naarukal kontraalaattal opttik naadi paathayilekku kadannupokunnu. ithaanu "swinging-flashlight testt"-nte adisthaanam.
thamasaseshi nashtappedunnathum thudarchayaaya pupillary dilation okkulomottar nadic oru kshathatthinte saannidhyam soochippikkum.

