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Examine the speech
Published in Hani TS Benamer, Neurology for MRCP PACES, 2019
Adie’s pupil, however, is occasionally seen in neurology clinics. It is a unilateral dilated pupil that does not react to light (or shows only a sluggish reaction) in young or middleaged women. Holmes-Adie syndrome is a combination of Adie’s pupil and reduced or absent tendon reflexes.
Hypereosinophilic syndrome
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
Ocular symptoms, particularly blurred vision, may be related to microemboli or local thrombosis. Adie syndrome (pupillotonia), keratoconjunctivitis sicca, and scleritis are the other main forms of ocular involvement [24,25].
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Published in Anton Sebastian, A Dictionary of the History of Medicine, 2018
Adie Syndrome Holmes-Adie syndrome. Myotonic pupils and absent tendon reflexes. Described by London ophthalmologist, James Ware (1756–1815) in 1813. Myotonic pupils were also described in 1902 by Strassburger and the complete syndrome was recognized by Charles Markus in 1905. Robert Foster Moore (b 1878) later reported 15 cases of tonic pupils which he referred to as ‘non-lutic Argyll Robertson pupils’. Dublin-born London neurologist, Gordon Holmes (1876–1965), described 19 cases, all females, under the title ‘partial irridoplegia associated with other diseases of the nervous system’ in 1931. He also introduced the term, tonic pupils. William John Adie (1886–1935), an Australian-born English physician, after whom the syndrome is named, described it independently first under the title ‘pseudo-Argyll Robertson pupils with absent tendon reflexes’ in 1931 and later as ‘tonic pupils with absent tendon reflexes’. Adie graduated in medicine from Edinburgh in 1911 and worked at several hospitals in London.
Tonic Pupil in Cytomegalovirus Anterior Uveitis in an Immunocompetent Adult Male – A Case Report
Published in Ocular Immunology and Inflammation, 2018
Kalpana Babu, Deepika C. Parameswarappa, Bhagya Sudheer
Involvement of the ciliary ganglion, short ciliary nerves in the orbital, intraocular or suprachoroidal spaces can cause tonic pupil. Tonic pupils are generally divided into local, neuropathic, and Adie syndrome.2 The local tonic pupil is typically unilateral and is due to orbital or systemic lesions that affect the ciliary ganglion or short ciliary nerves in isolation. It is seen in herpes zoster, chicken pox, measles, diphtheria, syphilis, Lyme disease, sarcoidosis, influenza, sinusitis, Vogt-Koyanagi-Harada disease (VKH), rheumatoid arthritis, giant cell arthritis, viral hepatitis, choroiditis, metastatic choroidal and orbital tumors, blunt and penetrating orbital injury, postintraocular and orbital surgeries, laser photocoagulation, and intraocular siderosis. Occurrence of tonic pupil has never been reported in CMV-related anterior uveitis3 (Medline search). The supersensitivity to pilocarpine 0.125% in our case confirmed the diagnosis. In our case, the neurological examination including deep tendon reflexes was normal.
Ross Syndrome
Published in Neuro-Ophthalmology, 2020
Manikanta Damagatla, Pratyusha Ganne, Rakesh Upparakadiyala, Prabhakaran N
The first case of Ross syndrome was described by Ross in 1958.2 Ever since there have been only a handful of cases reported worldwide. Some believe this to be a combination of two separate syndromes namely Harlequin syndrome and Holmes-Adie syndrome.3 Recent evidence suggests a decrease in sudomotor, vasomotor and pilomotor innervation in the skin of patients with Ross syndrome.4–6 Hence, there is a lack of sweating and cutaneous vasoregulation leading to heat intolerance. The iodine-starch test helps to demarcate areas of intact sweating and anhidrotic areas. Areas of intact sweating stain positive.7 Our patient showed no staining on the left side of her back and had patchy staining on the right side of her back (Figure 2). Tonic pupil results from damage to the ciliary ganglion or postganglionic parasympathetic nerve fibres.8 The exact cause of areflexia has not been found. Some postulate damage to the dorsal roots, sensory ganglia or the afferent fibres in the spinal cord.9,10 Tonic pupil may be present unilaterally or bilaterally and areflexia may be generalised. The tonic pupil shows a hypersensitivity response to dilute pilocarpine drops and this may be performed to confirm the diagnosis of postganglionic parasympathetic denervation hypersensitivity.11 The exact pathogenesis of the autonomic ganglion damage is uncertain but it is postulated that there is a congenital lack of factors that promote the survival of these neurons leading to their apoptosis. Some studies have suggested an autoimmune basis for the disease with some patients testing positive for different antibodies like anti-nuclear (ANA), SSA, SSB and anti-thyroid antibodies.12,13 Nolano et al. showed that this condition is progressive but benign.6
Systemic Markers in Ophthalmic Manifestations of Post Corona Virus Disease-19 (COVID-19)
Published in Ocular Immunology and Inflammation, 2023
Srinivasan Sanjay, Sai Bhakti Mistra, Sithun Kumar Patro, Ankush Kawali, Rohit Shetty, Padmamalini Mahendradas
Corona virus disease (COVID-19) has been associated with ophthalmic manifestations which can occur during or following the infection. These include conjunctivitis, anterior uveitis, reactivation of quiescent uveitis, episcleritis, scleritis, posterior segment manifestations like cotton wool spots, retinal vascular occlusions, panuveitis, retinitis, papillophlebitis, vitritis, central serous chorioretinopathy, acute retinal necrosis, ophthalmic artery occlusion, and Adie syndrome.1–14