Document 3 : Reconstitution du trajet des fibres nerveuses dans la région du chiasma optique
21 août 2012[important]
Consigne :
Exploiter les cas cliniques appropriés pour reconstituer le trajet des voies nerveuses entre chaque œil et le thalamus (les corps genouillés latéraux) en complétant le schéma distribué visible plus bas.
[/important]
Il est indiqué que le patient Y, dont un secteur de la portion occipitale de l’hémisphère droit a été détruit consécutivement à un AVC, manifeste un déficit visuel dans l’hémi-champ gauche. Ce déficit visuel touchant chacun des deux yeux, on est amené à envisager que l’hémisphère cérébral gauche doit traiter certaines informations en provenance de l’œil droit et d’autre en provenance de l’œil gauche.
Un croisement des voies visuelles semble donc envisageable. Il s’agit alors d’explorer la zone de rencontre des nerfs optiques issus de chaque œil , c’est-à-dire le chiasma optique. On utilise pour cela le cas de la patiente Z. Il est indiqué que cette patiente manifeste une perte de champ visuel sur les deux côtés, c’est-à-dire un déficit de la partie gauche de l’hémi-champ de son œil gauche ainsi que de la partie droite de l’hémi-champ de son œil droit. Il est précisé que ces symptômes sont une conséquence d’un adénome hypophysaire qui comprime la zone centrale du chiasma optique. On est donc amené – compte-tenu des connaissances sur le champ visuel monoculaire – à comprendre que :
- les zones latérales du chiasma optique (non lésées chez la patiente Z) contiennent les fibres nerveuses véhiculant les message nerveux respectivement issus de la rétine temporale de l’œil droit et de l’œil gauche ;
- la zone centrale du chiasma optique (lésée chez la patiente Z) contient des fibres nerveuses conduisant les messages nerveux respectivement issus de la rétine nasale de l’œil droit et de l’œil gauche ;
- le croisement des fibres nerveuses respectivement issues de la rétine nasale de l’œil droit et de l’œil gauche est prouvé par les déficits des hémi-champs gauches de chaque œil chez le patient Y ;
- l’absence de croisement des fibres nerveuses respectivement issues de la rétine temporale de l’oeil droit et de l’oeil gauche est prouvé par l’absence de déficit de l’hémi-champ droit chez le patient Y.
On construit alors le schéma suivant, à partir du schéma initial :
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