light-near dissociation

WordNet

1. very thin and insubstantial; "thin paper"; "light summer dresses"
2. make lighter or brighter; "This lamp lightens the room a bit" (同)illume, illumine, light_up, illuminate
3. a condition of spiritual awareness; divine illumination; "follow Gods light" (同)illumination
4. having abundant light or illumination; "they played as long as it was light"; "as long as the lighting was good" (同)lighting
5. (physics) electromagnetic radiation that can produce a visual sensation; "the light was filtered through a soft glass window" (同)visible_light, visible_radiation
6. any device serving as a source of illumination; "he stopped the car and turned off the lights" (同)light_source
7. the visual effect of illumination on objects or scenes as created in pictures; "he could paint the lightest light and the darkest dark" (同)lightness
8. a particular perspective or aspect of a situation; "although he saw it in a different light, he still did not understand"
9. a person regarded very fondly; "the light of my life"
10. a visual warning signal; "they saw the light of the beacon"; "there was a light at every corner"
11. an illuminated area; "he stepped into the light"
12. mental understanding as an enlightening experience; "he finally saw the light"; "can you shed light on this problem?"
13. public awareness; "it brought the scandal to light"
14. (used of color) having a relatively small amount of coloring agent; "light blue"; "light colors such as pastels"; "a light-colored powder" (同)light-colored
15. moving easily and quickly; nimble; "the dancer was light and graceful"; "a lightsome buoyant step"; "walked with a light tripping step" (同)lightsome, tripping
16. having relatively few calories; "diet cola"; "light (or lite) beer"; "lite (or light) mayonnaise"; "a low-cal diet" (同)lite, low-cal, calorie-free
17. less than the correct or legal or full amount often deliberately so; "a light pound"; "a scant cup of sugar"; "regularly gives short weight" (同)scant, short
18. (of sleep) easily disturbed; "in a light doze"; "a light sleeper"; "a restless wakeful night" (同)wakeful
19. (physics, chemistry) not having atomic weight greater than average; "light water is ordinary water"
20. (used of soil) loose and large-grained in consistency; "light soil"
21. characterized by or emitting light; "a room that is light when the shutters are open"; "the inside of the house was airy and light"
22. demanding little effort; not burdensome; "light housework"; "light exercise"
23. designed for ease of movement or to carry little weight; "light aircraft"; "a light truck"
24. easily assimilated in the alimentary canal; not rich or heavily seasoned; "a light diet"
25. having little importance; "losing his job was no light matter"
26. intended primarily as entertainment; not serious or profound; "light verse"; "a light comedy"
27. not great in degree or quantity or number; "a light sentence"; "a light accent"; "casualties were light"; "light snow was falling"; "light misty rain"; "light smoke from the chimney"
28. of comparatively little physical weight or density; "a light load"; "magnesium is a light metal--having a specific gravity of 1.74 at 20 degrees C"
29. of little intensity or power or force; "the light touch of her fingers"; "a light breeze"
30. of the military or industry; using (or being) relatively small or light arms or equipment; "light infantry"; "light cavalry"; "light industry"; "light weapons"
31. psychologically light; especially free from sadness or troubles; "a light heart"
32. closely resembling the genuine article; "near beer"; "a dress of near satin"
33. not far distant in time or space or degree or circumstances; "near neighbors"; "in the near future"; "they are near equals"; "his nearest approach to success"; "a very near thing"; "a near hit by the bomb"; "she was near tears"; "she was close to tears"; "had a close call" (同)close, nigh
34. being on the left side; "the near or nigh horse is the one on the left"; "the animals left side is its near or nigh side" (同)nigh
35. near in time or place or relationship; "as the wedding day drew near"; "stood near the door"; "dont shoot until they come near"; "getting near to the true explanation"; "her mother is always near"; "The end draws nigh"; "the bullet didnt come close"; "dont get too close to the fire" (同)nigh, close
36. a state in which some integrated part of a persons life becomes separated from the rest of the personality and functions independently (同)disassociation
37. (chemistry) the temporary or reversible process in which a molecule or ion is broken down into smaller molecules or ions
38. the act of removing from association
39. apparatus for supplying artificial light effects for the stage or a film
40. the craft of providing artificial light; "an interior decorator must understand lighting"
41. set afire or burning; "the lighted candles"; "a lighted cigarette"; "a lit firecracker" (同)lit

PrepTutorEJDIC

1. 〈U〉『光,光線』;明るさ / 〈U〉夜明け;日中;日光 / 〈C〉『明かり』(太陽・灯火など光を出すもの) / 〈U〉《時にa~》光輝(brightness),(目などの)輝き / 〈C〉(点火するための)火,火花 / 〈C〉明かり採り,採光窓 / 〈C〉《通例単数形で》(絵などの)明るい部分 / 〈U〉(…についての)知識,情報,理解《+『on』+『名』》 / 〈C〉(ものを見る)観点,見地;相 / 〈C〉この世に光を与える人;指導的な人物 / …‘に'『火をつける』《+『up』+『名』+『名』+『up』》 / …‘に'『明かりをつける』,‘を'照らす《+『up』+『名,』+『名』+『up』》 / 〈人〉‘を'明かりをつけて案内する / 〈表情など〉‘を'明るくする《+『up』+『名,』+『名』+『up』》 / 〈物が〉火がつく,点火する;明かりがつく《+『up』》 / 明るくなる,晴れ晴れする《+『up』》 / 『明るい』 / (色が)『薄い』
2. (重量が)『軽い』 / (いろいろな事について,その程座・量が)軽い,小さい / 『軽快な』 / 軽装の / 肩のこらない;気軽な / 手軽な,骨の折れなし / (食べ物が)消化のよい,もたれない / ふらふらする,目まいのする / アルコール分の少ない / (パンなどが)ふんわりした / (重量が)軽く / (程度が)軽く,容易に;軽装で
3. (車・馬などから)降りる《+『from』+『名』》(alight) / (木などに)〈鳥などが〉止まる《+『on』(『upon』)+『名』》 / (…に)〈打撃・運などが〉突然ふりかかる《+『on』(『upon』)+『名』》
4. (空間的・時間的に)(…の)『近くに』,(…に)接近して《+『to』+『名』》 / 《しばしば複合語を作って》『ほとんど』(almost, nearly) / (空間的・時間的に)『近い』,接近した / (関係などが)『身近な』 / 『きわどい』,やっとの / (空間的・時間的に)…『に近く』,『の近くに』 / (状態などが)…に近く,…しそうで / (時間・空間上)…‘に'近づく / 近づく,接近する
5. 「ほとんど…,ほぼ…」の意を表す
6. 分離[作用];解離
7. 照明,点火 / 照明方法(装置)

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/03/25 14:32:56」(JST)

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[Wiki en表示]

Nerve: Ciliary ganglion
Detailed view of nerves of lateral orbit showing the ciliary ganglion immediately behind the globe of the eye.
Latin	ganglion ciliare
Gray's	p.888
From	Parasympathetic root of ciliary ganglion, Sympathetic root of ciliary ganglion, Sensory root of ciliary ganglion
To	Short ciliary nerves

The ciliary ganglion is a parasympathetic ganglion located in the posterior orbit. It measures 1–2 millimeters in diameter and contains approximately 2,500 neurons. Preganglionic axons from the Edinger-Westphal nucleus travel along the oculomotor nerve and form synapses with these cells. The postganglionic axons run in the short ciliary nerves and innervate two eye muscles:

• the sphincter pupillae constricts the pupil, a movement known as Miosis. The opposite, Mydriasis, is the dilation of the pupil.
• the ciliaris muscle contracts, releasing tension on the Zonular Fibers, making the lens more convex, also known as accommodation.

Both of these muscles are involuntary – they are controlled by the autonomic nervous system.

It is one of four parasympathetic ganglia of the head and neck. (The others are the submandibular ganglion, pterygopalatine ganglion, and otic ganglion).

Anatomy

Scheme showing sympathetic and parasympathetic innervation of the pupil and sites of lesion in a Horner's syndrome.

Pathways in the Ciliary Ganglion. Green = parasympathetic; Red = sympathetic; Blue = sensory

Three types of nerve fibers run through the ciliary ganglion: parasympathetic fibers, sympathetic fibers and sensory fibers. Only parasympathetic fibers form synapses in the ganglion. The other two types of nerve fibers simply pass through. In classical anatomy, the ciliary ganglion is said to have three “roots:”

• a parasympathetic root of ciliary ganglion (or motor root)
• a sympathetic root of ciliary ganglion
• a sensory root of ciliary ganglion

Diseases

Adie tonic pupil

Main article: Adie syndrome

Diseases of the ciliary ganglion produce a tonic pupil. This is a pupil that does not react to light (it is “fixed”) and has an abnormally slow and prolonged response to attempted near vision (accommodation).

When a patient with an Adie pupil attempts to focus on a nearby object, the pupil (which would normally constrict rapidly) constricts slowly. On close inspection, the constricted pupil is not perfectly round. When the patient focuses on a more distant object (say the far side of the room), the pupil (which would normally dilate immediately) remains constricted for several minutes, and then slowly dilates back to the expected size.

Tonic pupils are fairly common – they are seen in roughly 1 out of every 500 people. A patient with anisocoria (one pupil bigger than the other) whose pupil does not react to light (does not constrict when exposed to bright light) most likely has Adie syndrome – idiopathic degeneration of the ciliary ganglion.

Physiology

The strange behavior of tonic pupils was first explained by Irene Loewenfeld in 1979. The ciliary ganglion contain many more nerve fibers directed to the ciliary muscle than nerve fibers directed to the constrictor pupillae – roughly twenty times more. The ciliary muscle is also more massive than the constrictor pupillae, again by a factor of twenty. Based on these observations, Loewenfeld proposed an explanation of the tonic pupil. She noted that pathological destruction of nerve cells in the ciliary ganglion that is found in all cases of Adie pupil. In her own words:

Let’s say that in a given fresh Adie’s pupil, a random 70% of the cells in the ciliary ganglion stop working; and that, in a couple of months, these neurons re-grow and randomly re-innervate both intraocular sphincters (the ciliary muscle and the iris sphincter). Some parasympathetic light-reaction neurons that were originally destined for the iris sphincter will end up innervating the ciliary muscle. But there will not be enough of them to budge that big muscle, so there will be no detectable accommodation with exposure to light. The other way around, it is a different story. There will be plenty of accommodative neurons re-growing into the iris sphincter, and it won’t take very many of them to make a little muscle like the iris sphincter contract. This means that every time the patient accommodates her gaze to a near object, some of the innervation to the ciliary muscle will spill over into the iris and constrict the pupil.

Loewenfeld’s theory is now generally accepted. It explains the defining features of a tonic pupil:

(1) The pupil does not react to light. The original light-reaction neurons have been destroyed.

(2) Tonic constriction with attempted near vision. Aberrant regeneration of nerve fibers intended for the ciliary muscle causes abnormal, tonic contraction of the pupil with accommodation.

(3) Segmental iris constriction. When carefully examined under magnification, the iris does not constrict uniformly with attempted near vision. Only the re-innervated segments contract, producing a slightly irregular contour to the pupil.

(4) [Denervation supersensitivity]. Like any denervated muscle, the iris becomes supersensitive to its normal neurotransmitter (in this case, acetylcholine). Very weak solutions of cholinergic substances such as pilocarpine (that have no effect on the normal iris) cause the denervated iris to constrict.

Tonic pupils are usually due to Adie syndrome, but other diseases can denervate the ciliary ganglion. Peripheral neuropathies (such as diabetic neuropathy) occasionally produce tonic pupils. Herpes zoster virus can attack the ciliary ganglion. Trauma to the orbit can damage the short ciliary nerves. Anything that denervates the ciliary ganglion will produce a tonic pupil due to aberrant nerve regeneration.

Adie syndrome

Adie syndrome is tonic pupil plus absent deep tendon reflexes. Adie syndrome is a fairly common, benign, idiopathic neuropathy that selectively affects the ciliary ganglion and the spinal cord neurons involved in deep tendon reflex arcs. It usually develops in middle age, although it can occur in children. A variant of Adie syndrome, Ross syndrome, affects sweating as well.

Early in the course of Adie syndrome (when the cells of the ciliary ganglion have been destroyed, but before regeneration has occurred) the pupil will be fixed and dilated. The sphincter pupillae will be paralyzed. There will be no response to accommodation – the ciliary muscle is also paralyzed.

With aberrant nerve regeneration, the pupil will remain fixed, but it will constrict with attempted near vision. The constriction will be abnormal (“tonic”).

Late in the course of Adie syndrome, the pupil becomes small (as all pupils do with old age). It will still be “fixed” (it will not constrict to bright light) and it will continue to show abnormal, tonic constriction with attempted near vision.

Light-near dissociation

In some neurological disorders, the pupil does not react to light, but it does react to accommodation. This is called “light-near dissociation”.

In Adie syndrome, damage involving the ciliary ganglion manifests light-near dissociation and a tonically dilated pupil (usually unilateral).

Other causes of light-near dissociation involve damage to the brainstem,^{[citation needed]} where a tonic pupil is not produced. Brainstem causes of light-near dissociation include Argyll Robertson pupil and Parinaud syndrome.

Irene Loewenfeld is generally credited for being the first physiologist to make this distinction.

References

Additional images

• Plan of oculomotor nerve.

• The right sympathetic chain and its connections with the thoracic, abdominal, and pelvic plexuses.

• Diagram of efferent sympathetic nervous system.

• Sympathetic connections of the ciliary and superior cervical ganglia.

External links

• SUNY Figs 29:03-04 - "A deeper dissection of the right orbit from a superior approach."
• Atlas image: n2a4p2 at the University of Michigan Health System - "Branches of Trigeminal Nerve, Lateral View"
• Cell Centered Database - Ciliary ganglion
• lesson3 at The Anatomy Lesson by Wesley Norman (Georgetown University) (orbit5)
• cranialnerves at The Anatomy Lesson by Wesley Norman (Georgetown University) (III, V)

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. 瞳孔不同患者へのアプローチ approach to the patient with anisocoria
• 2. 緊張性瞳孔 tonic pupil
• 3. ウェルニッケ脳症 wernickes encephalopathy

English Journal

• Acute isolated bilateral mydriasis: case reports and review of the literature.

• Sato H, Naito K, Hashimoto T.
• Case reports in neurology.Case Rep Neurol.2014 Mar 20;6(1):74-7. doi: 10.1159/000360849. eCollection 2014.
• Isolated bilateral internal ophthalmoplegia is a rare and problematic condition affecting activities of daily living. Herein, we describe the cases of 2 patients with postinfectious isolated bilateral internal ophthalmoplegia, i.e., mydriasis without external ophthalmoplegia. One patient demonstrate
• PMID 24803906

• 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

• Dorsal midbrain syndrome with loss of motor fusion: a rare association.

• Gregory ME1, Rahman MQ, Cleary M, Weir CR.
• Strabismus.Strabismus.2011 Mar;19(1):17-20. doi: 10.3109/09273972.2010.545468. Epub 2011 Jan 27.
• INTRODUCTION: Dorsal midbrain syndrome (DMS) is characterized by upgaze paralysis, convergence-retraction nystagmus, and eyelid retraction. Impaired downgaze and pupillary light-near dissociation may co-exist, while less common features including exotropia and convergence paralysis have also been de
• PMID 21271797

Japanese Journal

• 視神経障害を合併した Fisher 症候群

• 古賀 紀子,石川 弘,伊藤 雄,南 正之,水谷 智彦
• 日本眼科學会雜誌 112(9), 801-805, 2008-09-10
• NAID 10024370086

Related Links

• light-near dissociation - Definition - Mondofacto

light-near dissociation definition from the mondofacto online medical dictionary ... Search dictionary help light-near dissociation --> pupillary light-near dissociation medical dictionary A stronger near pupil response than light response ...

• Light near dissociation | Online references | cyclopaedia.net

References for "Light near dissociation" online, at universities and in literature... cyclopaedia.net cyclopaedia.net Twittern Light near dissociation Ask Mr-Know-It-All Light near dissociation The ciliary ganglion is a parasympathetic ...

Related Pictures

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★リンクテーブル★

リンク元	「対光近見反射解離」
関連記事	「light」「near」「dissociation」「lighting」

「対光近見反射解離」

　　[★]

英

light-near dissociation

同

対光近見反応解離

関

対光反射、近見反射

「light」

　　[★]

• n.

• 光、光線、見地、

• adj.

• (比較級lighter)軽い、明るい

関

bright、photic、photoradiation、point of view、ray、viewpoint、visible light、visible radiation

　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　

「near」

　　[★]

• adv. prep.

• 付近に、近くに

関

adjacent、approximate、close、closely、nearby、neighboring、proximity、vicinity

　 　 　 　 　 　

「dissociation」

　　[★]

• n.

• 解離

関

detachment、dissection、dissociate、dissociative disorder、dissociative reaction、fugue、maceration、unbinding

　 　 　 　

「lighting」

　　[★]

• n.

• 照明

関

illumination