Significance of the Argyll Robertson pupil in clinical medicine. Edinburgh Medical Journal 1869 15: 487-493 Dacso CC, Bortz DL. Four cases of spinal myosis : with remarks on the action of light on the pupil.
Some authorities think a partial oculomotor (III) nerve palsy or a lesion of the ciliary ganglion is more likely.Īrgyll Robertson D. It is usually caused by a neurosyphilitic lesion interrupting the fibers that run from the pretectal nucleus to the parasympathetic nuclei (Edinger-Westphal nuclei) of the oculomotor nerve on both sides. In multiple sclerosis and sarcoidosis, magnetic resonance imaging has shown lesions in the periaqueductal gray matter at the level of the Edinger-Westphal nucleus, but these cases lacked miosis and may be classified as pseudo-Argyll Robertson pupil. Argyll Robertson pupil ls characterized by a small pupil, which Is of fixed size and does not react to light but does contract with accommodation. Key words: Pupil, reflex, miosis, Argyll Robertson, autonomous nerve. A lesion in the tectum of the (rostral) midbrain proximal to the oculomotor nuclei has been claimed. Afterwards, it was clearly de- monstrated its relationship with tertiary neurosyphilis. The neuroanatomical substrate of the Argyll Robertson pupil is uncertain. Miosis and pupil irregularity are inconstant findings in some of these situations, in which case the term "pseudo-Argyll Robertson pupil" may be preferred. Hereditary motor and sensory neuropathies (Charcot-Marie Tooth disease Dejerine-Sottas hypertrophic neuropathy) There are, however, a number of recognized causes of ARP besides neurosyphilis, including:
If this pathological diagnosis is suspected, a helpful clinical concomitant is the associated loss of deep pain sensation, as assessed, for example, by vigorously squeezing the Achilles tendon (Abadie’s sign). The Argyll Robertson pupil was originally described in the context of neurosyphilis, especially tabes dorsalis. Although pupil involvement is usually bilateral, it is often asymmetric, causing anisocoria. There may be an incomplete response to mydriatic drugs. Since the light reflex is lost, testing for the accommodation reaction may be performed with the pupil directly illuminated: this can make it easier to see the response to accommodation, which is often difficult to observe when the pupil is small or in individuals with a dark iris. In other words, there is light-near pupillary dissociation (ARP = accommodation reaction preserved). It fails to react to light (reflex iridoplegia), but does constrict to accommodation (when the eyes converge). I will try again tomorrow.The Argyll Robertson pupil is small (miosis) and irregular. Sometimes it is the quiet voice at the end of the day saying. Balthazar ML, França MC Jr, de Castro R, Costa AL, Maciel JA Jr Arq Neuropsiquiatr 2008 Dec 66(4):901-2. fixed pupil a pupil that does not react either to light or on. Studies have failed to demonstrate a focal localising lesion. The pathophysiologic mechanism which produces an Argyll Robertson pupil is unclear. This observation facilitates a proper diagnosis of neurosyphilis. Trigemino autonomic cephalalgia and Argyll Robertson pupil. Argyll Robertson pupil one that is miotic and responds to accommodation effort, but not to light. Adie's pupil is caused by damage to peripheral pathways to the pupil (parasympathetic neurons in the ciliary ganglion that cause pupillary constriction to bright light and with near vision). PRA: Pupillary Response Absent (to light stimulus).Įssentially, the consequent neuronal damage yields a pupillary non-response to light,īut not to accommodation. Of each word in "Argyll-Robertson pupil:" The best way to remember this testing approach is to create an acronym using the first letters When light is shined into either eye, there is no direct or consensual pupillary reflex.įurther, the pupils do not dilate when the light is removed.īut when an accommodative stimulus is provided (i.e., a near test), the pupils constrict
In these patients, the pupils typically are very small in both bright light and Patients suspected of neurosyphilis often exhibit a characteristic sign known as Argyll-Robertson Click here to view larger image.Īlthough pupil testing can be challenging, there is great value to these measurements.įortunately, new technologies have been developed to measure pupil movements electronically.
Difficulty in obtaining pupil measurements with a standard swinging flashlight test can be overcome with advanced electronic technologies, like RAPDx (Konan Medical).
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