Neurosyphilis : $b Modern systematic diagnosis and treatment presented in one hundred and thirty-seven case historiesSouthard, Elmer Ernest
Science
Neurosyphilis : $b Modern systematic diagnosis and treatment presented in one hundred and thirty-seven case histories
Southard, Elmer Ernest
Neurosyphilis
2. What is the nature of stiff pupils? A pupil is called stiff in
the sense of the Argyll-Robertson pupil if it fails to react to
illumination either of itself or of the other eye and at the same
time if it reacts properly in convergence and accommodation. Of
course the stiffness of a blind eye must not be regarded as an
Argyll-Robertson pupil. In a case of right-sided Argyll-Robertson
pupil, therefore, the left pupil reacts properly both to direct
illumination of itself and to illumination of the right eye, but
the right eye fails to react to illumination of either eye. Such
an Argyll-Robertson right pupil will remain of the same width both
in darkness and in light. Clinicians agree that the
Argyll-Robertson is diagnosticated rather too frequently than too
seldom, and this by reason of the fact that a sluggishness of
light reaction is interpreted as stiffness. The sign, as is well
known, has come to be regarded as almost pathognomonic of tabetic
or paretic neurosyphilis. Nonne, however, has found among 510
cases of alcoholism, nine instances of Argyll-Robertson pupil and
19 cases of sluggish light reactions. The pathological anatomy of
this sign is still doubtful although a number of schematic
accounts are available; among hypotheses, one may think of an
elective effect of the tabetic or paretic degeneration upon reflex
collaterals. The explanation would then resemble that for absent
knee-jerks and kindred reflex disorders. We should then
hypothesize a loss of the finer processes of the terminal
arborizations about the cells of the nucleus of sphincter nucleus
iridis. However, the situation of the sphincter iridis has not yet
been absolutely determined.
When a pupil is said to be entirely stiff it means that it reacts
neither to light nor accommodation. This condition not
infrequently follows the partial stiffness or Argyll-Robertson
reaction.
3. Is the Argyll-Robertson pupil more tabetic than paretic? This has
been claimed at times, but in point of fact, the Argyll-Robertson
pupil is very frequent in paresis, and so also are posterior
column changes. According to statistics of Bumke, 36% of tabetics
fail to show the Argyll-Robertson pupil, and 38% of paretics.
When, however, finer methods, such as those standardized by
Weiler, with photographic records, are employed, the number of
cases without at least a tendency to the Argyll-Robertson pupil
becomes much smaller.
In connection with the important question as to the classical
Argyll-Robertson pupil and pupillary sluggishness to light, it may
be inquired what are the ocular signs in neurosyphilis? Joffroy
has tabulated the signs in 300 general paretics as follows:
Public-domain text, read in full here on John Shaqi.
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