BOF: 2.14
A sixty-year-old male presents
with a history of difficulty in walking. On examination of his eyes you note
that his pupils are small and irregular. They do not react to light but react
to accommodation. He also has bilateral ptosis and has wrinkling of his
forehead. The abnormality that this patient has is:
a)
Holmes-Adie pupil
b)
Argyll-Robertson pupil
c)
Horner’s syndrome
d)
Relative afferent pupillary defect
e)
Myasthenia gravis
Answer:
b)
The Argyll-Robertson
pupil is thought to be due to a lesion in the tectum of the
midbrain in proximity to the oculomotor nuclei.
The pupils are small and irregular
and do not react to light but react to accommodation. Bilateral ptosis and
wrinkling of the forehead due to overcompensation by the frontalis muscle
suggests tabes dorsalis.
