Pupillary Signs Research Articles

Scalloped Pupils in Familial Amyloidosis

THE purpose of this report is to call attention to a pupillary sign of dominantly inherited amyloidosis. We encountered the sign, reported in 1952 by Andrade,1 in one of two brothers who were alrea...

Syndrome of incipient prechiasmal optic nerve compression. Progress toward early diagnosis and surgical management.

The identifying characteristics of the monocular<i>syndrome of incipient prechiasmal optic nerve compression</i>are slowly progressive dimming of vision with near normal acuity, poor color perception, positive Marcus Gunn pupillary sign, and normal appearance of the optic disc. Associated visual field defects are subtle and nondescript, but progressive. Even the smallest prechiasmal tumors causing this syndrome can now be detected and defined anatomically with modern neuroradiologic techniques, the most informative of which are serial polytomography of the optic canals and pneumotomography of the prechiasmatic cisterns. Microsurgical resection of the compressive lesion greatly reduces operative trauma and ensures the chance for prompt restoration of vision. Problems in diagnostic and surgical management of patients with incipient optic nerve compression are exemplified in reports of six cases.

Argyll Robertson and Münchhausen or Münchausen Or Munchausen

To the Editor:— Your well-intended editorial Eponyms ( 207 :1142, 1969) helped perpetuate the improper hyphenation of Douglas Argyll Robertson's name. This error is so widespread that public correction of your mistake will probably, not have an appreciable effect in diminishing its future frequency. However, since 1969 marks the centennial of the two publications 1,2 initially describing his pupillary sign, some extra effort seems warranted to keep the form of this eponym correct. A recent biographical sketch 3 and re-publication of his second paper on spinal myosis 4 are readily available sources of information about this remarkable Scotsman, who is said to have had no peer with either von Graefe knife or mashie niblick. A second error, which would be too minor to bother about, I suppose, had it not appeared in an article on the subject of eponyms, is the umlaut over the a in Munchausen's syndrome. The excellent

BRAIN SWELLING WITH ACUTE PURULENT MENINGITIS

A fetal case of acute meningitis in a child is reported to illustrate the orderly sequence of neurological signs indicating progressive brainstem compression, leading to death. The similarity of this neurological pattern to that seen in patients with supratentorial mass lesions is emphasized. Six cases of acute meningitis in infants and children are then reported who similarly showed signs of progressive brain swelling and herniation, in whom intravenous urea was used in treatment. In two children who were felt to be moribund with bulging anterior fontanel, coma, poorly reactive pupils, deteriorating respirations, and convulsions, the response to the infusion of urea was dramatic, with improvement in consciousness, respirations, and pupillary signs, and cessation of convulsions. Two other children had a less dramatic response to urea, but were definitely improved. Two were thought to have had possible benefit. No child showed deleterious effects from treatment with urea. The mechanism of action of osmotic agents in the treatment of brain swelling is discussed. Hypertonic intravenous urea was felt to have been a safe and possibly valuable adjunct to the therapy of the patients of this study.

Vascular lesions of the visual cortex with brain herniation through the tentorial incisura. Neuro-ophthal-mologic considerations.

Expanding supratentorial lesions, regardless of location, can cause ischemic or hemorrhagic infarction of one or both occipital lobes by compression of the posterior cerebral arteries against the tentorium. Compression of the posterior cerebral artery and resultant infarction of the visual cortex are frequently observed by the neuropathologist. Such infarctions occur secondary to herniation of the brain through the tentorial incisura. Herniations in turn are the direct result of increased supratentorial pressure. The clinical correlation of some of the ophthalmologic signs occurring with transtentorial herniation of the brain (such as pupillary and oculomotor signs) has been described in great detail. 1,2 However, compression of branches of the posterior cerebral arteries as a cause of homonymous hemianopsia and visual agnosia in patients with increasing intracranial pressure has seldom been mentioned in the ophthalmologic literature. (Lyle, 3 Huber, 4 and Walsh 5 discussed the general problem but presented no clinical material.) This report

Observations of gastric motility during gastric crisis.

THE PROBLEM of syphilis involving the stomach itself has been well covered in the literature. There is no typical x-ray picture. A gumma in the pyloric region may simulate pyloric stenosis or may appear to be an ulcer or a new growth. An infiltrating lesion of the wall closely resembles and cannot from a single study be separated from an infiltrating tumor. The commonest finding, however, is the hourglass deformity of the stomach. 1 Visceral attacks occur in 10% of persons suffering from tabes dorsalis. They may constitute an initial symptom and often occur in the preataxic stage; however, they are usually accompanied by pupillary signs or infection in the blood or spinal fluid. Of the visceral crises the gastric type is commonest. The onset generally is featured by abrupt epigastric pain followed by retching and vomiting. Neither the pain nor the vomiting disappears with these ejections, and they may

A Pupillary Sign in Ruptured Ectopic Pregnancy

A Pupillary Sign in Ruptured Ectopic Pregnancy