![]() ![]() ![]() It is not known whether neurosyphilis itself (infection by Treponema pallidum) can cause tonic pupils, or whether tonic pupils in syphilis simply reflect a coexisting peripheral neuropathy. ![]() tonic) that are necessary to distinguish AR pupils from tonic pupils. The older literature on AR pupils did not report the details of pupillary constriction (brisk vs. The exact relationship between syphilis and the two types of pupils ( AR pupils and tonic pupils) is not known at the present time. A lesion in this area would involve efferent pupillary fibres on the dorsal aspect of the Edinger-Westphal nucleus (associated with the response to light) while sparing the fibres associated with the response to near, which lie slightly more ventrally. Research has implicated the rostral mid-brain in the vicinity of the cerebral aqueduct of the third ventricle as the most likely region of damage. Studies have failed to demonstrate a focal localising lesion. The pathophysiologic mechanism which produces an Argyll Robertson pupil is unclear. 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). Coordination good the arms.The two different types of near response are caused by different underlying disease processes. On attempting to rise from the recumbent to sitting position both legs rise up from the bed. Gait: stands only with support, in and then on a broad base attempts at walking result the legs being thrown forward stiffly in turn: there is no attempt in balancing. clonus Abdominal reflexes present, left greater than right. Lower limbs: motor power fairly good knee-jerks exaggerated and equal ankle-jerks exaggerated, right more active than left no ankle both plantar reflexes extensor. Upper limbs: motor power good tendon-jerks present and equal. Voluntary movements of left side of face weak. Ocular movements: and deficient lateral deviation to right left, but can sometimes complete the move- ment in both directions. Vision: fails to see people until quite close can see fingers. Cranial nerves: pupils moderate in size, equal, react sluggishly to light and briskly to accommodation. Head abnormally large, but nothing grossly abnormal on X-ray examination of skull. Proceedings of the Royal Society of Medicine SAGE ġ76 Proceedings of the Royal Society of Medicine 12 Condition on Examination.-Well developed and moderately intelligent answers questions when confidence is gained. ![]() Disseminated Sclerosis with Argyll-Robertson Pupil Disseminated Sclerosis with Argyll-Robertson Pupilġ76 Proceedings of the Royal Society of Medicine 12 Condition on Examination.-Well developed and moderately intelligent answers questions when confidence is gained. ![]()
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