ABSTRACT
The Holmes-Adie syndrome is characterized by the presence of tonic pupil associated with absence or diminution of deep tendon reflexes. In some cases there may be autonomous nerve dysfunction. The mechanism that causes the disorder is not fully known, but is believed to be caused by denervation of the postganglionic supply to the sphincter of the pupil and the ciliary muscle which can occur following viral disease. Typically it affects young adults and is unilateral in 80% of cases, although it may develop in the contralateral eye in months or years. We report a case of a woman presenting typical signs of this syndrome, in which pharmacological test was essential for diagnosis.
A Síndrome de Holmes-Adie É caracterizada pela presença de pupila tônica associada à diminuição ou ausência dos reflexos tendíneos profundos. Em alguns casos pode haver disfunção nervosa autônoma. O mecanismo que causa a desordem não é totalmente conhecido, mas acredita-se que seja causada pela desnervação do suprimento pós-ganglionar para o esfíncter da pupila e para o músculo ciliar, que pode ocorrer após doença viral. Tipicamente afeta adultos jovens e é unilateral em 80% dos casos, embora possa se desenvolver no olho contralateral em meses ou anos. Nós relatamos o caso de uma mulher apresentando sinais típicos desta síndrome, em que o teste farmacológico foi fundamental para o diagnóstico.
Subject(s)
Humans , Female , Adult , Miotics , Pilocarpine , Tonic Pupil/diagnosis , Adie Syndrome/diagnosisABSTRACT
A 46-year-old female patient was admitted to the intensive care unit (ICU) after liver transplantation. About an hour later after the ICU admission, she had no pupillary light reflex. Both pupils were also fixed at 5 mm. Patients who undergo liver transplantation are susceptible to neurologic disorders including hepatic encephalopathy, thromboembolism and intracranial hemorrhage. Abnormal pupillary light reflex usually indicates a serious neurologic emergency in these patients; however, benign neurologic disorders such as peripheral autonomic neuropathy or Holmes-Adie syndrome should also be considered. We experienced a case of fixed pupillary light reflex after liver transplantation diagnosed as peripheral autonomic neuropathy.
Subject(s)
Female , Humans , Middle Aged , Adie Syndrome , Emergencies , Hepatic Encephalopathy , Intensive Care Units , Intracranial Hemorrhages , Liver Transplantation , Liver , Nervous System Diseases , Peripheral Nervous System Diseases , Pupil , Reflex , Reflex, Pupillary , ThromboembolismABSTRACT
A 46-year-old female patient was admitted to the intensive care unit (ICU) after liver transplantation. About an hour later after the ICU admission, she had no pupillary light reflex. Both pupils were also fixed at 5 mm. Patients who undergo liver transplantation are susceptible to neurologic disorders including hepatic encephalopathy, thromboembolism and intracranial hemorrhage. Abnormal pupillary light reflex usually indicates a serious neurologic emergency in these patients; however, benign neurologic disorders such as peripheral autonomic neuropathy or Holmes-Adie syndrome should also be considered. We experienced a case of fixed pupillary light reflex after liver transplantation diagnosed as peripheral autonomic neuropathy.
Subject(s)
Female , Humans , Middle Aged , Adie Syndrome , Emergencies , Hepatic Encephalopathy , Intensive Care Units , Intracranial Hemorrhages , Liver Transplantation , Liver , Nervous System Diseases , Peripheral Nervous System Diseases , Pupil , Reflex , Reflex, Pupillary , ThromboembolismABSTRACT
Orbital trauma and surgery are recognised aetiological factors of tonic pupil. Tonic or Adie's pupil is an efferent pupil defect in which light reactions to one or more segments of the iris sphincter are lost due to the postganglionic parasympathetic nerves damage from ciliary ganglion. There is loss of part or all of the light reflex and decrease in accommodative functions at near. We report a case of tonic pupil in a 42-year-lady after a successful surgical removal of an orbital cavernous haemangioma.
Subject(s)
Tonic Pupil , Adie SyndromeSubject(s)
Female , Humans , Young Adult , Adie Syndrome/complications , Autonomic Nervous System/physiopathology , Headache/complications , Adie Syndrome/physiopathology , Headache/physiopathology , Parasympathetic Nervous System/physiopathology , Reflex , Trigeminal Nerve/physiopathology , Young AdultABSTRACT
BACKGROUND: The clinical and laboratory findings of five patients with tonic pupil (TP) and neuropathy were reviewed for the comprehension of pathogenesis of TP in neuropathy. METHODS: Immunological and nerve conduction studies (NCS) were performed in three patients with Sjogren's syndrome (SS), Miller-Fisher syndrome (MFS), and Adie's syndrome. RESULTS: Upon initial examination, there were no definite sicca syndromes in patients of SS, despite intolerable sensory symptoms. The TP in MFS was improved after intravenous immunoglobulin. Of the cranial neu-ropathies, trigeminal sensory neuropathy was frequent finding. Deep tendon reflexes were absent in all five patients.Absent sensory nerve action potentials and prolonged R1 and R2 of the blink reflex were detected in two SS patients with syncope and asymmetric sensory loss. CONCLUSIONS: These findings in SS patients implicated the possibility of a selective lesion at the level of the dorsal root- or trigeminal- or autonomic- ganglions complicating the TP. In view of the sensory ataxia, opthalmoplegia, areflexia, slow and decreased sensory NCS in the extremity and prolonged R1 and R2, a demyelinating process of postganglionic parasympathetic nerves were suspected to be the cause of the tonic pupil in MFS. Adie's syndrome along with flushing of the left side of the face and chest after exercise, suggested segmental postganglionic lesions of the sympathetic and parasympathetic peripheral nervous systems. In patients with complicat-ing TP and asymmetric progressive sensory neuropathy, the SS has to be considered even if the patient denies the pres-ence of sicca symptoms at first and SS-A/SS-B autoantibody is negative.
Subject(s)
Humans , Action Potentials , Adie Syndrome , Ataxia , Autoantibodies , Blinking , Comprehension , Extremities , Flushing , Ganglion Cysts , Immunoglobulins , Miller Fisher Syndrome , Neural Conduction , Peripheral Nervous System , Reflex, Stretch , Sjogren's Syndrome , Syncope , Thorax , Tonic PupilABSTRACT
A patient with pre-existing bilateral tonic pupils presented with simultaneous bilateral glaucomatocyclitic crisis. Deep tendon reflexes were absent although they were documented to be present 6 years ago. A possibility of a progressive autonomic dysfunction in both these conditions is discussed.
Subject(s)
Adie Syndrome/complications , Aged , Female , Humans , Iridocyclitis/complications , Ocular Hypertension/complicationsABSTRACT
BACKGROUND: Adie's tonic pupil consists of mydriasis, accommodation defect, decreased light reflex, and tonic near reflex. When tonic pupil is combined with hypo- or areflexia, it is called Holmes-Adie syndrome. CASE: Fifty-two-year-old and 37-year-old female patients showed unilateral dilated irregular pupil, decreased light reflex, and decreased or absent DTR. When 0.125% pilocarpine was dropped on the dilated pupil, the pupil was constricted after pilocarpine application. Somatosensory evoked potentials were within normal ranges, and H-reflex responses were absent or delayed.
Subject(s)
Adult , Female , Humans , Adie Syndrome , Evoked Potentials, Somatosensory , H-Reflex , Mydriasis , Pilocarpine , Pupil , Reference Values , Reflex , Tonic PupilABSTRACT
El síndrome de Adie se caracteriza por una denervación colinérgica pupilar y su diagnóstico se basa en la respuesta a la pilocarpina diluida. Frecuentemente se asocia a pérdida de reflejos osteotendinosos, hipohidrosis y otros trastornos autonómicos. Estudiamos 9 pacientes con síndrome de Adie desde el punto de vista clínico, electrofisiológico y autonómico. La respuesta pupilar a la pilocarpina se comparó con un grupo control. Los parámetros clínicos y electrofisiológicos fueron similares a los de la literatura del tema. En la mitad de los pacientes los reflejos autónomicos cardiovasculares estaban alterados. En los controles, varios sujetos con mayor edad presentaron respuestas pupilares de denervación colinérgica. La pupila de Adie frecuentemente se asocia a otros trastornos autonómicos, en grado variable y que no siguen un patrón fijo
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Adie Syndrome/physiopathology , Pilocarpine , Tonic Pupil/physiopathologySubject(s)
Humans , Female , Adolescent , Adult , Mydriasis , Reflex, Abnormal , Ciliary Body/injuries , Hypesthesia , Tonic Pupil , Adie Syndrome/diagnosisABSTRACT
Sjogren's syndrome is a hererogenous autoimmune disease characterized by progressive destruction of the exocrine glands and accompanied by a variety of autoimmune phenomena. Sjogren's syndrome patients can develop symptoms of ocular and oral dryness as well as extraglandular complications including central and peripheral nervous system disease. Sometimes neuropathy precedes the diagnosis of Sjogren's syndrome. Adiets syndrome is characterized by tonic pupil and the absence of tendon reflex. Sweating abnormality and chronic peripheral polyneuropathy can also be present. We report a case of primary Sjogren's syndrome preceded by Adie's syndrome with peripheral neuropathy. A 26-year-old woman was admitted for photophobia and paresthesia. On examination, her pupils were anisocoric and did not react to light but constricted promptly to pilocarpin. Sensation decreased on her left side of body and deep' tendon reflexes were absent. Biopsy of minor salivary gland demonstrated infiltration by lymphocyte consistent with Sjogren's syndrome, but Schirmer test was negative. So she was diagnosed as Adie's syndrome with peripheral neuropathy. Five month later she complained of dry eye and dizziness. Rose bengal staining was positive. Sjogren's syndrome was diagnosed and she was discharged with local therapy for the sicca symptoms.
Subject(s)
Adult , Female , Humans , Adie Syndrome , Autoimmune Diseases , Biopsy , Diagnosis , Dizziness , Exocrine Glands , Lymphocytes , Paresthesia , Peripheral Nervous System Diseases , Photophobia , Polyneuropathies , Pupil , Reflex, Stretch , Rose Bengal , Salivary Glands, Minor , Sensation , Sjogren's Syndrome , Sweat , Sweating , Tonic PupilABSTRACT
A Síndrome de Adie, caracterizada por pupila tônica, hipossensibilidade corneana e hipo ou arreflexia dos tendöes profundos, é uma patologia neuroftalmológica benigna, porém evolutiva, cujo conhecimento apresentava, além do interese do ponto de vista acadêmico, aspectos práticos muito úteis, evitando exames dispendiosos e invasivos. Os autores revisam o assunto e apresentam um estudo de 12 pacientes com a Síndrome, salientando suas características, fisiopatologia e diagnóstico
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Adie Syndrome , Pilocarpine/therapeutic use , Adie Syndrome/diagnosis , Adie Syndrome/physiopathology , Adie Syndrome/drug therapyABSTRACT
Adie's tonic pupil usually consists of mydriasis, defect in accommodation. Poor or absent light reflex, and tonic near reflex, It is usually unilateral, but rarelY observed bilaterally. The pupillary abnormalities often accompany areflexia, which is called Adie syndrome collechvely, Other autonomic dysfunction especially hypohidrosis. Are rarely reported in association with Adie syndrome. We recently experienced 2 cases of bilateral Adie's pupils in 2 women, one of whom had hypohidrosis, and the other had areflexia. So we report 2 cases with bilateral Adie's pupils with a review of literature.
Subject(s)
Female , Humans , Adie Syndrome , Hypohidrosis , Mydriasis , Reflex , Tonic PupilABSTRACT
A síndrome de Holmes-Adie consiste de pupila tônica, arreflexia patelar e disfunçäo autômica. As explicaçöes desses diferentes síntomas têm-se baseado em achados neuropatológicos e eletrofisiológicos. Neste trabalho apresenta-se uma hipótese imunológica para a fisiopatogenia da síndrome, de modo semelhante à da síndrome de Guillain-Barré
Subject(s)
Humans , Adie Syndrome/immunologyABSTRACT
Se trata de la presentación de seis casos con un síndrome pupilar benigno generalmente unilateral que se presenta en ausencia de otros signos y síntomas que manifiesten alguna enfermedad neurológica o sistémica
Subject(s)
Child , Adolescent , Adult , Humans , Male , Female , Adie Syndrome/pathology , Reflex, Pupillary , Pupil/pathologyABSTRACT
Se revisan los aspectos clínicos, diagnóstico y significado de la Pupila de Adie, en especial algunos signos que demuestran el compromiso de la acomodación y su medición
Subject(s)
Humans , Reflex, Pupillary , Adie Syndrome/diagnosisABSTRACT
Os autores apresentam um caso de pupila tonica e discutem aspectos clinicos e fisiopatologicos dessa sindrome. Eles fazem consideracoes sobre lacunas na compreensao da etiopatogenia da sindrome
Subject(s)
Humans , Female , Adie SyndromeABSTRACT
Descricao de um caso tipico de sindrome de Adie. Durante o periodo de convalescencia, garantiu-se uma boa cooperacao binocular mediante o uso de lente multifocal no olho afetado. Pacientes com grande exigencia visual podem ser grandemente beneficiados com esse procedimento