What is A 45 year old male had history of unprotected sexual intercourse 15 year back, what is the pupil condition in this patient? and explain in detail?
(B) Accommodation reflection positive...[?]As a questions shows unprotected sexual intercourse 15 years back in a 45 year old male suggestive of a patient suffered syphilitic disease & developing presently with Tabes Dorsalis with Argyll-Robertson Pupil.ARGYLL-ROBERTSON PUPILArgyll Robertson Pupil is usually caused by lesion, almost invariably syphilitic in origin.It is characterised by absence reaction to light, but Accommodation Reflex Present in a miotic pupil.Mnemonic: ARP stands for Argyll Robertson Pupil, i.e., Accommodation Reflex PresentClinical features:Pupil <3mm in diameterIrregular, unequal, miotic pupilNearly always bilateralTotal absence of reaction to lightReaction to convergence & accommodation presentPoor response to pain & mydriaticAbsent ilio-spinal responseAtrophic patches & depigmentation of irisNormal media & optic nerveLesion:Not known.Most probable site may be mid brainAetiology: (pathognomonic of Tabes dorsalis)Neurosyphilis (Tabes dorsalis, G.P.I. & Meningo-vascular syphilis)DiabetesChronic alcoholismEpidemic encephalitisMultiple sclerosisCNS degenerative diseasesTumours of mid brainSyringomyeliaHerpes zoster ophthalmicusChronic hypertrophic polyneuritisTrauma behind the eyeVARIOUS TYPES OF OPHTHALMIC PUPILSInverse-Argyll Robertson Pupil:*. Clinical features:*. Reflex to light is retained*. Loss of pupillary reflex to accommodation & convergence.*. Site of lesion: Mid-brain (connection between nucleus of Perlia & Edinger-Westphal nucleus).*. Aetiology:*. Diphtheria*. Corpora quadrigeminal tumoursTonic Pupil (Adie's Pupil):Adie's pupil... inability of pupil to respond to light on near stimuli, usually unilateral & occurs in young women.*. Clinical features:*. F>M, Usually in 3rd decade*. Frequently young adult woman*. 80% unilateral, moderately dilated*. Delayed or diminished direct & consensual reaction to the light*. May be associated with loss of tendor reflexes (Adie's syndrome).*. Reaction to mydriatics & miotics are normal*. Once developed is permanent*. Site of lesion: Damage to ciliary ganglior & aberrant regeneration of nerve flow.*. Test: A weak 0.25% Pilocarpine instillation causes tonic pupil to constrict but not normal pupil.*. Aetiology: Obscure but not syphilis.Hutchinson's Pupil:*. Clinical features:*. Develops after head injury*. Widely dilated immobile pupil on the same side*. Loss of both direct & consensual reflexes to tight.*. Site of lesion: Stretching of 3rd nerve on the same side.*. Aetiology: Diagnostic of fracture skull with meningeal haemorrhage.Horner's Syndrome:*. Clinical features:*. Unilateral miosis*. Ptosis*. Enophthalmos*. Absence of sweating on the ipsi-lateral face & neck*. Site of lesion:*. Sympathetic pathway in the brainstem*. Upper spinal cord*. Peripheral sympathetic chain*. Aetiology:*. Cervical vertebral fracture*. Tabes dorsalis*. Syringomyelia*. Cervical cord tumour*. Apical tuberculosis*. Apical bronchogenic carcinoma*. Mediastinal tumour*. Aneurysm of carotid or subclavian artery*. Cervical lymphadenopathyHippus:*. Clinical features:*. Alternate rhythmic dilatation and constriction of pupils*. Associated with respiratory rhythm*. Site of lesion:*. Imbalance of sympathetic & parasympathetic division of ANS*. Aetiology:*. Recovery of III nerve palsy*. Disseminated sclerosis*. Syphilis*. NeoplasmsMarcus Gunn pupil:*. Normal sized pupil, both the direct & consensual reaction are present, Relative Afferent Pupillary Defect (RAPD) on swinging light test, (caused by optic nerve or severe retinal disease).