1/6. tonic pupil and sarcoidosis.PURPOSE: To present a case of tonic pupil associated with enhancement in the region of the ciliary ganglion on magnetic resonance imaging in a patient with sarcoidosis. DESIGN: Observational case report. methods: A 52-year-old woman with sarcoidosis had a right pupil exhibiting sectoral palsy to light and light-near dissociation. RESULTS: Topical administration of 0.1% pilocarpine demonstrated supersensitivity of the right pupillary sphincter muscle. magnetic resonance imaging (MRI) with contrast revealed enhancement in the region of the right ciliary ganglion. CONCLUSIONS: tonic pupil may be a manifestation of sarcoidosis, and in such cases, MRI may show enhancement at the level of the ciliary ganglion. sarcoidosis should be included in the differential diagnosis of tonic pupil.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
2/6. Bilateral tonic pupils associated with neurosyphilis.BACKGROUND: To describe 4 patients with bilateral tonic pupils in neurosyphilis. CASES: Four young men had pupillary abnormalities, which involved irregular shapes, large sizes, tonic reactions, and vermiform movements of both pupils with light-near dissociation. Cholinergic supersensitivity defined bilateral tonic pupils. OBSERVATIONS: neurosyphilis was diagnosed in these patients on the basis of ocular and laboratory findings. CONCLUSIONS: Bilateral tonic pupils may be important as initial findings in neurosyphilis. We conclude that patients with bilateral tonic pupils should undergo serologic tests for syphilis.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
3/6. Segmental facial anhidrosis and tonic pupils with preserved deep tendon reflexes: a novel autonomic neuropathy.A 31-year-old woman had exertional right-sided hemifacial flushing and sweating. Examination demonstrated slightly dilated pupils with absent constriction to light and a tonic near response and redilatation, features consistent with adie syndrome. Neurological examination was otherwise normal, including preservation of deep tendon reflexes. magnetic resonance imaging of brain and spine were normal. The combination of unilateral loss of sudomotor and vasomotor activity without loss of ocular sympathetic innervation fulfills the diagnosis of Harlequin syndrome. The combination of Harlequin and Adie syndromes has been called Ross syndrome, but the preservation of deep tendon reflexes precludes a diagnosis of Ross syndrome in our patient. This previously undescribed variant adds further complexity to the spectrum of autonomic neuropathies.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
4/6. tonic pupil and Czarnecki's sign following third nerve palsy.A 71-year-old woman developed abnormal pupillary function in one eye after a third nerve palsy. Stimulation with light caused segmental constriction of the pupil, the near reflex was normal, and gaze upward elicited constriction of portions of the sphincter that were unreactive to light. This combination of findings has not been reported previously. We believe that this case supports the idea that a tonic pupil can be caused by aberrant reinnervation of the ciliary ganglion.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
5/6. guillain-barre syndrome with bilateral tonic pupils.A 53-year-old patient with guillain-barre syndrome preceded by herpes simplex virus infection developed bilateral tonic pupils with light-near dissociation. Pharmacological tests for pupils suggested postganglionic involvement of the parasympathetic and sympathetic nerves. A demyelinating process of peripheral autonomic nerves was suspected to be the cause of the tonic pupils and autonomic dysfunction.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
6/6. Transient tonic pupils in botulism type B.We report a 29-year-old woman who developed unilateral unreactive mydriasis and cycloplegia after 5 days of persistent constipation. During the next hours the patient complained of dry mouth and difficulties in swallowing food; iris and ciliary muscle palsies spread over the second eye. Ocular motility was normal and there were no clinical signs of neuromuscular involvement. Conventional electromyography and evoked muscle action potentials following repetitive nerve stimulation were normal; single-fiber electromyography showed normal jitter and absence of blocking. The diagnosis of botulism was considered as most likely, and the patient was given botulinum antitoxin. The post-treatment course was characterized by bilateral tonic pupillary reaction to near, sectoral iris contractions to light and pupillary constriction to 2 mm in 40 min following topical instillation of 0.1% pilocarpine. Ocular manifestations completely disappeared within 5 weeks. botulism type B toxin was demonstrated in the pretreatment stool of the patient but not the serum.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |