Argyll-Robertson pupil

アーガイル・ロバートソン瞳孔

WordNet

1. a Welsh pirate credited with having taken more than 400 ships (1682-1722) (同)Bartholomew Roberts
2. United States writer remembered for his historical novels about colonial America (1885-1957) (同)Kenneth Roberts
3. United States evangelist (born 1918) (同)Oral Roberts
4. United States biochemist (born in England) honored for his discovery that some genes contain introns (born in 1943) (同)Richard J. Roberts, Richard John Roberts
5. the contractile aperture in the center of the iris of the eye; resembles a large black dot
6. young of any of various canines such as a dog or wolf (同)whelp
7. a covered gravy holder of silver or other metal containing a detachable central vessel for hot water to keep the gravy warm (同)argyle
8. United States basketball guard (born in 1938) (同)Oscar Robertson, Oscar Palmer Robertson

PrepTutorEJDIC

1. (一般にschoolに学ぶ)『生徒』;(個人指導を受けている)生徒,門下生,弟子
2. ひとみ,瞳孔(どうこう)
3. =puppy / (キツネ・オオカミ・アザラシなどの)子 / 〈雌犬が〉子犬を生む

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/10/15 09:35:18」(JST)

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Argyll Robertson pupil
Classification and external resources
Specialty	ophthalmology
ICD-10	A52.1, H58.0
ICD-9-CM	094.89, 379.45
DiseasesDB	33036

Argyll Robertson pupils (“AR pupils”) are bilateral small pupils that reduce in size on a near object (they “accommodate”), but do not constrict when exposed to bright light (they do not “react” to light). They are a highly specific sign of neurosyphilis, and might also be a sign of diabetic neuropathy. In general, pupils that “accommodate but do not react” are said to show light-near dissociation- i.e., it is the absence of a miotic reaction to light, both direct and consensual, with the preservation of a miotic reaction to near stimulus (accommodation-convergence). A video of AR pupils and light-near dissociation is available here

AR pupils are extremely uncommon in the developed world. There is continued interest in the underlying pathophysiology, but the scarcity of cases makes ongoing research difficult.

History

In the early 20th century, William John Adie described a second type of pupil that could “accommodate but not react.” Adie’s tonic pupil is usually associated with a benign peripheral neuropathy (Adie syndrome), not with syphilis.

When penicillin became widely available in the 1940s, the prevalence of AR pupils (which develop only after decades of untreated infection) decreased dramatically. AR pupils are now quite rare. A patient whose pupil “accommodates but does not react” almost always has a tonic pupil, not an AR pupil.

In the 1950s, Loewenfeld distinguished between the two types of pupils by carefully observing the exact way in which the pupils constrict with near vision. The near response in AR pupils is brisk and immediate. The near response in tonic pupils is slow and prolonged.

Pathophysiology

The two different types of near response are caused by different underlying disease processes. 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). The pathophysiologic mechanism which produces an Argyll Robertson pupil is unclear, but is believed to be the result of bilateral damage to the pretectal nuclei in the midbrain. Studies have failed to demonstrate a focal localising lesion. Research has implicated the rostral midbrain in the vicinity of the cerebral aqueduct of the third ventricle as the most likely region of damage. 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. The exact relationship between syphilis and the two types of pupils (AR pupils and tonic pupils) is not known at the present time. The older literature on AR pupils did not report the details of pupillary constriction (brisk vs. tonic) that are necessary to distinguish AR pupils from tonic pupils. Tonic pupils can occur in neurosyphilis. 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.

Thompson and Kardon (2006) summarize the present view:

The evidence supports a midbrain cause of the AR pupil, provided one follows Loewenfeld’s definition of the AR pupil as small pupils that react very poorly to light and yet seem to retain a normal pupillary near response that is definitely not tonic.

To settle the question of whether the AR pupil is of central or peripheral origin, it will be necessary to perform iris transillumination (or a magnified slit-lamp examination) in a substantial number of patients who have a pupillary light-near dissociation (with and without tonicity of the near reaction), perhaps in many parts of the world.

Parinaud syndrome

A third cause of light-near dissociation is Parinaud syndrome, also called dorsal midbrain syndrome. This uncommon syndrome involves vertical gaze palsy associated with pupils that “accommodate but do not react." The causes of Parinaud syndrome include brain tumors (pinealomas), multiple sclerosis and brainstem infarction.

Due to the lack of detail in the older literature and the scarcity of AR pupils at the present time, it is not known whether syphilis can cause Parinaud syndrome. It is not known whether AR pupils are any different from the pupils seen in other dorsal midbrain lesions.

See also

• Adie syndrome
• Anisocoria
• Cycloplegia
• Marcus Gunn pupil
• Miosis
• Parinaud's syndrome
• Syphilis

References

External links

• -1791688703 at GPnotebook
• Pearce JM (2004). "The Argyll Robertson pupil". J. Neurol. Neurosurg. Psychiatr. 75 (9): 1345. doi:10.1136/jnnp.2003.014225. PMC 1739227. PMID 15314131. 
• Illustration at health-pictures.com
• Illustration at mrcophth.com

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 神経梅毒 neurosyphilis
• 2. 緊張性瞳孔 tonic pupil
• 3. 全身性疾患および感染に関連した網膜血管炎 retinal vasculitis associated with systemic disorders and infections
• 4. 胃排出遅延の病因および診断 etiology and diagnosis of delayed gastric emptying

English Journal

• Progressive visual and hearing loss secondary to neurosyphilis.

• Draper EM1, Malloy KA.
• Optometry and vision science : official publication of the American Academy of Optometry.Optom Vis Sci.2012 Nov;89(11):e65-71.
• PURPOSE: There is a rising incidence of syphilis in economically advanced countries. Early diagnosis can spare the patient devastating vision and hearing loss, as well as other significant morbidity. Ocular presentations of neurosyphilis are varied and numerous, requiring syphilis to be considered i
• PMID 23026790

• The clinical presentation and imaging manifestation of psychosis and dementia in general paresis: a retrospective study of 116 cases.

• Zheng D1, Zhou D, Zhao Z, Liu Z, Xiao S, Xing Y, Suo WZ, Liu J.
• The Journal of neuropsychiatry and clinical neurosciences.J Neuropsychiatry Clin Neurosci.2011 Summer;23(3):300-7. doi: 10.1176/appi.neuropsych.23.3.300.
• In recent years, occurrence of "general paresis (GP)" has increased significantly because of the increasing incidence of syphilis in China. Early diagnosis plays a very important role for effective treatment. Incidence is becoming extensive enough to warrant an updated investigation of the clinical
• PMID 21948891

• [MRI features of neurosyphilis].

• Brisset M1, Chadenat ML, Cordoliani Y, Kamga-Tallom R, D'Anglejean J, Pico F.
• Revue neurologique.Rev Neurol (Paris).2011 Apr;167(4):337-42. doi: 10.1016/j.neurol.2010.08.012.
• INTRODUCTION: Neurosyphilis is rare today. It arises on average 20 years after poorly treated or untreated primary syphilis. Considering the decline in the incidence of syphilitic meningo encephalitis and the little known MRI aspects, we report the case of a patient affected by neurosyphilis occurr
• PMID 21440277

Japanese Journal

• Pseudo-Argyll Robertson pupil of patients with spinocerebellar ataxia type 1 (SCA1)

• Mabuchi Kazunori,Yoshikawa Hiroaki,Takamori Masaharu,Yokoji Hidehiro,Takahira Masayuki
• Journal of Neurology Neurosurgery and Psychiatry 65(4), 612-613, 1998-10
• … A pseudo-Argyll Robertson pupil is a neurological sign indicating a normal near reflex but the absence of a light reflex (light-near dissociation), a lack of miosis, and pupil irregularity. …
• NAID 120001088389

• 梅毒性視神経炎の1症例

• 牛山 佳子,音成 龍司,遠藤 智代子,東島 正泰,高木 維彦,大野 新治
• あたらしい眼科 = Journal of the eye 13(2), 263-265, 1996-02-29
• NAID 10018594624

• 神経梅毒におけるア-ガイル・ロバ-トソン瞳孔およびその他の瞳孔異常--末梢障害の検索を中心として

• 岡田 文彦
• 北海道医学雑誌 58(3), p266-270, 1983-05
• NAID 40003534332

Related Links

• Argyll Robertson pupil - definition of Argyll Robertson pupil ...

pupil (P) [pu´pil] the opening in the center of the iris through which light enters the eye; see also Plate 17. Adie's pupil tonic pupil. Argyll Robertson pupil one that is miotic and responds to accommodation effort, but not to light. fixed ...

• Argyll Robertson pupil - definition of Argyll Robertson pupil by ...

However, in pathological anisocoria, abnormally reacting smaller pupils can be caused by Horner's Syndrome, Argyll Robertson pupil and iritis, whereas abnormally reacting larger pupils can be caused1 by a compressive third nerve ...

Related Pictures

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★リンクテーブル★

リンク元	「アーガイル・ロバートソン瞳孔」
関連記事	「pup」

「アーガイル・ロバートソン瞳孔」

　　[★]

英

Argyll-Robertson pupil, Argyll Robertson pupil

同

アーガイルロバートソン瞳孔 Argyll-Robertson瞳孔、反射性瞳孔強直 ridigitas pupillae reflectoria、アーガイル・ロバートソン徴候 Argyll-Robertson徴候

関

梅毒、神経梅毒、瞳孔。対光近見反射解離

対光反射　×　　、　　輻輳反射　○　　、　　縮瞳

概念

• 神経梅毒による瞳孔調節異常として報告された。以下のような眼徴候を呈する。

眼徴候

• 1. 直接対光反応・間接対光反応の欠如
• 2. 迅速な輻湊反応
• 3. 縮瞳

病因

• 中脳を障害するような疾患 (BET.206)。中脳視蓋前域から動眼神経自律神経核の末梢までの障害(医学事典)。

• 神経梅毒
• 糖尿病、多発性硬化症、脳炎、中枢神経系の変性疾患、アルコール性中毒

近見反射と対光反射の経路の異差

対光反射

• 網膜　→　視神経　→　視交叉　→　視索　→　上丘腕　→　視索前域　→　E-W核　→　動眼神経　→　毛様体神経節　→

近見反射

• 後頭葉視覚中枢　→　前頭葉眼領域　→　内包　→　脳脚　→　中脳　→　E-W核　→　動眼神経　→　毛様体神経節　→

<youtube>http://www.youtube.com/watch?v=C6vm7LOFrmI</youtube>

「pup」

　　[★]

子

関

child、filial