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The pupilloconstrictor (parasympathetic) bers arise in the Edinger-Westphal The pathway for the pupillary light re ex consists of three nucleus in the high midbrain, join the third cranial (oculomotor) parts (Fig 14-7): nerve, and synapse in the ciliary ganglion, which lies in the posterior part of the orbit The postganglionic bers then enter the 1 An afferent limb, whose bers originate in the retinal recepglobe via the short ciliary nerves; approximately 3 percent of the tor cells, pass through the bipolar cells, and synapse with the bers innervate the sphincter pupillae and 97 percent the ciliary retinal ganglion cells; axons of these cells run in the optic body The sphincter of the pupil comprises 50 motor units, accordnerve and tract The light re ex bers leave the optic tract ing to Corbett and Thompson.

The pupillodilator (sympathetic) just rostral to the lateral geniculate body and enter the high bers arise in the posterolateral part of the hypothalamus and demidbrain, where they synapse in the pretectal nucleus scend, uncrossed, in the lateral tegmentum of the midbrain, pons, 2 Intercalated neurons that give rise to the pupillomotor bers, medulla, and cervical spinal cord to the eighth cervical and rst which pass ventrally to the ipsilateral Edinger-Westphal nuand second thoracic segments, where they synapse with the lateral cleus and, via bers that cross in the posterior commissure, horn cells The latter cells give rise to preganglionic bers, most to the contralateral Edinger-Westphal nucleus (labeled of which leave the cord by the second ventral thoracic root and pretecto-oculomotor tract in Fig 14-7) proceed through the stellate ganglion to synapse in the superior 3 An efferent two-neuron pathway from the Edinger-Westphal cervical ganglion.

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The postganglionic bers course along the innucleus, synapsing in the ciliary ganglion, by which all moternal carotid artery and traverse the cavernous sinus, where they tor impulses reach the pupillary sphincter, as described join the rst division of the trigeminal nerve, nally reaching the above eye as the long ciliary nerve that innervates the dilator muscle of the iris Some of the postganglionic sympathetic bers also innerAlterations of the Pupils vate the sweat glands and arterioles of the face and Muller s muscle in the eyelid The pupils tend to be large in children and small in the aged, sometimes markedly miotic but still reactive (senile miosis) An asymmetry of the pupils of 03 to 05 mm is found in 20 percent or more The Pupillary Light Re ex of normal individuals.

A lesion that destroys only a small number of nerve cells in the Edinger-Westphal nucleus or ciliary ganglion The most common stimulus for pupillary constriction is exposure will cause paralysis of a sector or sectors of the iris and deform the of the retina to light Re ex pupillary constriction is also part of pupil to a pear or elliptical shape the act of convergence and accommodation for near objects (nearNormally the pupil constricts under a bright light (direct resynkinesis)..

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digits, moderate degree of mental retardation. Transmission as an autosomal dominant trait. Acrocephalosyndactyly IV (Pfeiffer syndrome). Turri-brachycephaly; broad, enlarged thumbs and great toes; partially exed elbows (radiohumeral or radioulnar synostoses); mild and variable mental retardation; autosomal dominant inheritance. Acrocephalopolysyndactyly V (Carpenter syndrome). Premature fusion of all cranial sutures with acrocephaly, at bridge of nose, medial canthi displaced laterally, excess digits and syndactyly, subnormal intelligence. Acrocephalosyndactyly with absent digits. High, bitemporally attened head; absent toes and syndactylic ngers; moderate mental retardation. Acrocephaly with cleft lip and palate, radial aplasia, and absent digits. Microbrachycephaly due to craniostenosis, cleft lip and palate, absent radial bones, severe mental retardation. Dyschondroplasia, facial anomalies, and polysyndactyly. Keel-shaped skull and ridge through center of forehead (metopic suture), short arms and legs, postaxial polydactyly and short digits, moderate mental retardation.

The round function rounds the elements of E to the nearest integers: >> round(E) -2-2-1r22 The ceil (short fbr ceiling) function rounds to the nearestintegerstoward infinity: (E) -1

Real foot Epidermis Like a skinny leg and foot balancing an egg (or oval fruit)

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