Eye lesion Qs - penelope24

[ArchivalUser]

Can someone please explain these pathologies to me specifically where the lesion is:

1. Argyll robertson - so what I do know is its tertiary syphillis and it accomodates but does not constrict in response to light. But where is the lesion. is this bilat or unilat. whats the defective pathway. Thank you.

2. Adie pupil- my understanding is there is damage to the ciliary ganglion so no psymp innervation means no constriction so this pupil stays dilated...so is there a problem with light reflex or accomodation or both? is this unilat or bilat

3. Marcus Gunn pupil - this affects afferent fibers so how does this present differently than a total optic nerve lesion?

Thank you!

[ArchivalUser]

1) “But where is the lesion.”
- No agreement on the site of the lesion, but believed in vicinity of pretectal nuclei/rostral to superior colliculi ( dorsal midb)
- “is this bilat or unilat” both usually bilateral
- “whats the defective pathway.” Pupils both direct & consensual candle relexses lost and accommodation/convergence Rxn intact. (as u mention that pathognomonic of tabes dorsalis/or taboparesis and also u can see other Pineal tumor, MS…) as accommodation refex preserved, rex to mydriatic poorly and no response to cholinergic.
2) “problem with light reflex or accommodation or both? is this unilat or bilat”
- Pupil Dilated RT however that react lazy to light but better to accommodation ( ciliary ganglion lesion as u know) respond to light may absent with full tonic ( bz adie sir name tonic pupil thus response to near point focus)
- Usually UNIlateral but may be Bilateral
3) “Marcus Gunn pupil - this affects afferent fibers so how does this present differently than a total optic nerve lesion?”
- Relative “A”fferent pupillary defect name in it ASYMMETIC ↓ light detection by signal transmission ( path of optic N/tract geniculate gangial/ EW nuclei) both pupils CONStrict less when light -> pupil affected eye than if you directed -> Unaffected eye ( swinging L test)
- Here quick review you shine life MGP -> pupils DON’T constrict completely, you shine L norm eye -> pupil constrict complete and u shine the rapid again in affected eye -> both pupils dilate ( as u can img an path w MS CNII are bumpy )
- In total optic N lesion -> you gone hv total visual loss not sure exactly what u asking here.

[ArchivalUser]

Let make sure my ATP not wasted here

Q)
A 45 y/o F post officer after many years decides to be evaluation by you. Overall, pat appears healthy, on PE pen light exam you decide to do more investigation and result reveals http://i.imgur.com/iXn9juS.png?1 company by reduce deep tendon reflexes. Just base on a img Dx?

[ArchivalUser]

@cardio - ahhh that makes much more sense. Thanks for answering all the questions I had!

[ArchivalUser]

hmm so this is marcus gunn pupil in the image?

[ArchivalUser]

Thanks to Dr. William Adie
DX in pat: Adie syndrome/ Holmes–Adie syndrome/Adie's tonic pupil (MC use)

[ArchivalUser]

A patient is capable of displaying pupillary constriction during an accommodation reaction but not in response to a direct-light stimulus. The lesion is most likely present in which of the following?

a)Optic nerve
b)Ventral cell column of CN III
c)Pretectal area
d)Visual cortex
e)EW nucleus of CN III

[ArchivalUser]

hmm I dont understand. Could you please explain why its Adie pupil? thanks!

[ArchivalUser]

is the answer to the 2nd ques C. pretectal bc this is argyll robertson?

[ArchivalUser]

---------------------------SIZE AND SIDE ----------------------LIGHT RXN--ACCOMMODATIVE RXN
Argyll Robertson pupil: Small/irregular/asymmetrical-------------No-------------YES---------------
Adie* /tonic pupil : fixed,later enlarged -> medium size---------No or poor----YES


*with tonic Rxn Tonic contraction to prolonged accommodation/asso areflexia as case just post officer. Please u get chance read about Adie syn if things are fogy let me know


At least Im happy to see u got 2nd q rt My ATP not wasted here
Happy study!