WordNet

the contractile aperture in the center of the iris of the eye; resembles a large black dot
young of any of various canines such as a dog or wolf (同)whelp

PrepTutorEJDIC

(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
ひとみ,瞳孔(どうこう)
=puppy / (キツネ・オオカミ・アザラシなどの)子 / 〈雌犬が〉子犬を生む
Guam

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/10/28 12:43:23」(JST)

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Marcus Gunn pupil or relative afferent pupillary defect (RAPD) is a medical sign observed during the swinging-flashlight test^[1] whereupon the patient's pupils constrict less (therefore appearing to dilate) when a bright light is swung from the unaffected eye to the affected eye. The affected eye still senses the light and produces pupillary sphincter constriction to some degree, albeit reduced.

The most common cause of Marcus Gunn pupil is a lesion of the optic nerve (between the retina and the optic chiasm) or severe retinal disease. It is named after Scottish ophthalmologist Robert Marcus Gunn.^[2]

Examination

The Marcus Gunn pupil is a relative afferent pupillary defect indicating a decreased pupillary response to light in the affected eye.^[3]

In the swinging flashlight test, a light is alternately shone into the left and right eyes. A normal response would be equal constriction of both pupils, regardless of which eye the light is directed at. This indicates an intact direct and consensual pupillary light reflex. When the test is performed in an eye with an afferent pupillary defect, light directed in the affected eye will cause only mild constriction of both pupils (due to decreased response to light from the afferent defect), while light in the unaffected eye will cause a normal constriction of both pupils (due to an intact efferent path, and an intact consensual pupillary reflex). Thus, light shone in the affected eye will produce less pupillary constriction than light shone in the unaffected eye.

A Marcus Gunn Pupil is distinguished from a total CN II lesion, in which the affected eye perceives no light. In that case, shining the light in the affected eye produces no effect.

Anisocoria is absent. A Marcus Gunn pupil is seen, among other conditions, in optic neuritis. It is also common in retrobulbar optic neuritis due to multiple sclerosis but only for 3–4 weeks, until the visual acuity begins to improve in 1–2weeks and may return to normal.^[4]

References

^ "utah.edu". Retrieved 2009-05-27.
^ doctor/2687 at Who Named It?
^ Pearce J (November 1996). "The Marcus Gunn pupil". J. Neurol. Neurosurg. Psychiatr. 61 (5): 520. doi:10.1136/jnnp.61.5.520. PMC 1074053. PMID 8937350.
^ Mumenthaler Neurology 4ed, Thieme 2004, page 486 Demyelinating diseases

External links

1611005962 at GPnotebook

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UpToDate Contents

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1. 成人における詳細な神経学的検査 the detailed neurologic examination in adults
2. 瞳孔不同患者へのアプローチ approach to the patient with anisocoria
3. Overview of eye injuries in the emergency department
4. 視神経炎：病態生理、臨床的特徴、および診断 optic neuritis pathophysiology clinical features and diagnosis
5. 成人における多発性硬化症の臨床的特徴 clinical features of multiple sclerosis in adults

English Journal

Acute sphenoid sinusitis induced blindness: a case report.

Reynolds SC1, Evans EM.
The Journal of emergency medicine.J Emerg Med.2012 Aug;43(2):e123-4. doi: 10.1016/j.jemermed.2011.06.122. Epub 2011 Nov 8.
BACKGROUND: Acute, isolated sphenoid sinusitis is a rare but potentially devastating clinical entity. Missing this diagnosis can lead to permanent vision loss due to injury of the optic nerve. Patients may present with preseptal inflammation, lid edema, chemosis, or ophthalmoplegia.OBJECTIVE: We rep
PMID 22070879

[Prognostic factors and visual outcome for open globe injuries with intraocular foreign bodies].

Maneschg OA1, Resch M, Papp A, Németh J.
Klinische Monatsblätter für Augenheilkunde.Klin Monbl Augenheilkd.2011 Sep;228(9):801-7. doi: 10.1055/s-0029-1245756. Epub 2010 Nov 29.
AIMS: The aim of this study was to evaluate the clinical features as well as the visual results and determine the prognostic factors after the removal of retained intraocular foreign bodies (IOFBs).PATIENTS AND METHODS: At our centre we conducted a non-randomised, non-comparative retrospective analy
PMID 21117017

[A case of bilateral horizontal gaze ophthalmoplegia: The 1+1 syndrome].

Bourre B1, Collongues N, Bouyon M, Aupy J, Blanc F, Speeg C, de Seze J.
Revue neurologique.Rev Neurol (Paris).2010 Dec;166(12):1028-31. doi: 10.1016/j.neurol.2010.06.005. Epub 2010 Aug 21.
INTRODUCTION: Oculomotor deficiencies in multiple sclerosis (MS) are frequently characterized by internuclear ophthalmpoplegia or isolated abduction or adduction palsies. Complete unilateral conjugate gaze paralysis and the "one and a half" syndrome are rare. Complete bilateral horizontal gaze paral
PMID 20728911

Japanese Journal

神経眼科の古典・原典：求心性瞳孔反応異常：Marcus Gunn pupil（Marcus Gunn）；pseudo-anisocoria（Kestenbaum）；swinging flashlight test（Levatin）；relative afferent pupillary defect（Thompson）

神経眼科 33(1), 37-46, 2016
NAID 130005143503

「マーカス・ガン瞳孔」

Marcus Gunn pupil
	The left optic nerve and the optic tracts. A Marcus Gunn pupil indicates an afferent defect, usually at the level of the retina or optic nerve. Moving a bright light from the unaffected eye to the affected eye would cause both eyes to dilate, because the ability to perceive the bright light is diminished.
Classification and external resources
DiseasesDB	29599