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 Answer BOF 2.10

 

   

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BOF: 2.10

 

A 30-year-old female is admitted for investigation of headache. On examination of her pupils you notice that her left pupil is semi-dilated and reacts slowly to both light and accommodation. Her visual acuity is normal, there is no field defect, no ptosis and eye movements are normal with no nystagmus or diplopia. Examination of the fundus does not reveal papilloedema. The pupillary abnormality in this patient is due to:

a)      Holmes-Adie syndrome

b)    Argyll-Robertson syndrome

c)      Horner’s syndrome

d)      3rd nerve palsy

e)      Relative afferent pupillary defect

Answer:

a)

The Holmes-Adie syndrome refers to a myotonic pupil, which reacts very slowly (or there is no reaction) to light and convergence. It is commoner in young females. It may be unilateral or bilateral. It may be associated with absence or depression of the tendon reflexes and rarely anhidrosis of the limbs.  It is due to denervation of the ciliary ganglion. The cause is not known

 

Revision Tip

 

Revise abnormalities of the pupils ACES for PACES page 487-490

 

 

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