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）』「2015/06/16 00:03:40」(JST)

wiki en

[Wiki en表示]

Argyll Robertson pupil
Classification and external resources
ICD-10	A52.1, H58.0
ICD-9	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. 胃運動機能不全：病因、臨床症状、および診断 gastroparesis etiology clinical manifestations and diagnosis

English Journal

• [A diplopia of unusual cause].

• Agard É1, Biotti D2, Malclès A3, Vighetto A2, Tilikete C2, Desestret V4.
• La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne.Rev Med Interne.2015 Nov;36(11):783-5. doi: 10.1016/j.revmed.2015.06.014. Epub 2015 Jul 10.
• PMID 26169184

• [Argyll-Robertson pupil.]

• Diaz Olaizola C1, Salvador Castellà N2, Garcia Caballero M2, Jerez Viñas N2, Galvez Suarez A3, Álvaro Rubio C4.
• Semergen / Sociedad Espanola de Medicina Rural y Generalista.Semergen.2015 Mar 2. pii: S1138-3593(15)00042-8. doi: 10.1016/j.semerg.2015.01.011. [Epub ahead of print]
• PMID 25743697

• 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

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

Related Links

• Argyll Robertson pupil - Wikipedia, the free encyclopedia

Argyll Robertson pupils (“AR pupils” or "Prostitute's Pupil") are bilateral small pupils that constrict when the patient focuses on a near object (they “ accommodate”), but do not constrict when exposed to bright light (they do not “ react” to light).

• Argyll Robertson Pupil

he Argyll Robertson pupil, a miotic pupil that responds to an accommodation effort but fails to react to direct light, has been described in medical literature for more than a century. This pupillary reaction (Sidebar) is a simple way to confirm the ...

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」「胚細胞腫瘍」
拡張検索	「pseudo-Argyll Robertson pupil」「Argyll-Robertson pupil」
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>

「胚細胞腫瘍」

　　[★]

英

germ cell tumor GCT, germ cell tumors GCTs

同

生殖細胞腫瘍、胚細胞性腫瘍、胚細胞腫

関

脳における胚細胞腫瘍(SCN.194)

• 胚腫 germinoma：高頻度(50-60%)。
• 奇形腫 teratoma
• 胎児性癌 embryonal carcinoma
• 卵黄嚢腫瘍 yolk sac tumor
• 絨毛癌 choriocarcinoma
• 混合型胚細胞腫瘍 mixed germ cell tumor

好発部位(SCN.194)

• 松果体部(53%)、トルコ鞍上部(20%)、大脳基底核(5.5%)　←　正中線上に多い傾向
• ジャーミノーマはトルコ鞍上部が多い

疫学(SCN.194)

• 西欧と比べ、アジア、特に日本で多い。
• 原発性脳腫瘍の約3%を占める
• 小児に多い。小児脳腫瘍の15%を占める
• 松果体に発生する腫瘍：男性に多い
• トルコ鞍上部に発生する腫瘍：性差無し

症状(SCN.194)

• 松果体部腫瘍：中脳水道を閉塞→水頭症。視蓋前野、上丘を圧迫→Parinaud症候群、Argyll Robertson pupil
• トルコ鞍上部腫瘍：尿崩症、視力・視野障害、下垂体前葉機能障害
• 基底核部腫瘍：片麻痺、不随運動、けいれん

「pseudo-Argyll Robertson pupil」

　　[★] 瞳孔緊張症。偽アーガイル・ロバートソン瞳孔

「Argyll-Robertson pupil」

　　[★] アーガイル・ロバートソン瞳孔

「pup」

　　[★]

子

関

child、filial