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Neuroinfectious Diseases
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Jeremy D. Young, Jesica A. Herrick, Scott Borgetti
Tabes dorsalis – T. pallidum infection of the posterior columns of the spinal cord and dorsal root ganglia that usually develops 20 years after initial exposure. Ataxia, focal pain syndromes, or paresthesias are common complaints. The Argyll–Robertson pupil, which occurs commonly, is a small pupil that does not respond to light, but only accommodation and convergence. Physical examination reveals decreased lower extremity reflexes, impaired proprioception, loss of fine touch, and vibratory sensation and sensory ataxia.
Clinical Neuroanatomy
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
In IIIrd nerve lesions, damage to the efferent pupilloconstrictor fibres produces a fixed dilated pupil even though the patient perceives light normally. Incomplete lesions may merely cause a slightly dilated pupil with a sluggish reaction – an important stage in the evolution of a IIIrd nerve palsy in a patient who is deteriorating following a head injury. A useful clue in a conscious patient developing a IIIrd nerve lesion is the almost invariable accompanying ptosis. This may be followed by diplopia due to paralysis of the superior rectus muscle (see ‘The oculomotor nerve (III)’ below). Argyll Robertson pupils due to meningovascular syphilis have become a great rarity. This is a small pupil, usually irregular, that does not react to light but reacts normally to accommodation.12
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Published in Anton Sebastian, A Dictionary of the History of Medicine, 2018
Argyll Robertson Pupil Light rigidity of the pupil. Douglas Argyll Robertson (1837–1909), an ophthalmologist at Edinburgh Royal Infirmary, described four cases of spinal meiosis in his remarks on the action of light on the pupil in the Edinburgh Medical Journal in 1869. This condition associated with taboparesis was later named after him. See Argyll Robertson, pupillary reaction.
Syphilitic meningomyelitis misdiagnosed as spinal cord tumor: Case and review
Published in The Journal of Spinal Cord Medicine, 2021
Huiqing Dong, Zheng Liu, Yunyun Duan, Dawei Li, Zhandong Qiu, Yaou Liu, Jing Huang, Chaodong Wang
Her physical examination on admission showed that she was alert and oriented. The cranial-nerve functions were normal. Argyll Robertson pupils, which fail to react to light but constrict during near vision, were not observed. Muscle tones were normal. The muscle strength of the right leg was grade 4/5 (Oxford scale), other muscles strength was normal. Pinprick sensation below T7 level was decreased. Vibration sensation below T12 level was reduced. Bilateral finger-nose tests were normal. Bilateral heel-knee-shin tests showed slight dysmetria. Romberg’s sign (A sign which is swaying of the body that occurs when the eyes are closed.) was positive. She was unable to perform tandem gait well. She had brisk deep tendon reflexes in the right lower limb and right flexor plantar response.
Neuro-Ophthalmic Manifestations of HIV Infection
Published in Ocular Immunology and Inflammation, 2020
Lynn K. Gordon, Helen Danesh-Meyer
Pupillary disturbances in HIV infection may be caused by infiltrative lesions of the brainstem. These can include light-near dissociation and anisocoria. Investigators have also identified that in patients who are HIV positive there is an abnormal pupil cycle time suggesting subclinical ocular autonomic dysfunction.57 Horner’s syndrome may occur with lesions anywhere along the sympathetic chain. The Argyll Robertson pupil, characterized by irregular, small-sized pupils, and light-near dissociation, is a classic manifestation of neurosyphilis. This finding is highly specific for syphilis although light-near dissociation can occur in dorsal midbrain syndrome.
Ocular Syphilis: An Update
Published in Ocular Immunology and Inflammation, 2019
Parthopratim Dutta Majumder, Elizabeth J. Chen, Janika Shah, Dawn Ching Wen Ho, Jyotirmay Biswas, Leo See Yin, Vishali Gupta, Carlos Pavesio, Rupesh Agrawal
Examination of the cerebrospinal fluid (CSF) is mandatory in patients with syphilitic nerve involvement, to confirm the diagnosis of neurosyphilis and subsequently, influence management. The central nervous system can be involved at any stage of syphilis and should be considered in patients with otherwise unexplained visual loss. Unequal, irregular and miotic pupils with light-near dissociation characterize the Argyll Robertson pupil, a classical finding in neurosyphilis. Argyll Robertson-like pupils can also be seen in patients with multiple sclerosis, diabetes mellitus, chronic alcoholism,and encephalitis.27