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Journal of Neurology, Neurosurgery, and... Oct 1993A cross-sectional study is reported in which 53 patients with Holmes-Adie syndrome have been subjected to a battery of tests of autonomic nervous function referable to...
A cross-sectional study is reported in which 53 patients with Holmes-Adie syndrome have been subjected to a battery of tests of autonomic nervous function referable to the cardiovascular system, to two objective tests of sweating function, and to subjective assessment of sweating by application of quinizarin powder followed by body heating. The majority of patients were consecutive referrals; none was selected because of clinical indications of autonomic dysfunction. Eighty three per cent of these patients had at least one, 57% at least two, and 40% at least three objective test abnormalities, as defined by values lying outside 95 percentiles of healthy subjects who were matched for age and subjected to the same tests. In the context of multiple testing, the probability of finding outside values was such that a minimum of 3 was required to define abnormality. On this basis 40% of patients were found to have significant evidence of autonomic dysfunction. The most frequent abnormalities were impaired digital vasoconstriction to cold (23%), a reduced heart rate response to the Valsalva manoeuvre (17%), and excessive variability in sweating between test sites (in one of the tests, 43%) which is consistent with patchy loss. Abnormal quinizarin test appearances were seen in 10 patients and in a further five patients the appearances were thought to be suggestive of abnormality. Though assessment of the results of this test are subjective, the observations are consistent with the findings obtained from the objective tests which were applied. Cardiovascular and sweating abnormality did not concur significantly and only the former was found to increase progressively with known duration of the pupillotonia. It is concluded that Holmes-Adie syndrome is commonly accompanied by progressive mild but widespread autonomic involvement but rarely is this symptomatic. If symptoms suggestive of autonomic neuropathy are found in a patient with tonic pupils, a careful search for some other generalised disorder is recommended.
Topics: Adie Syndrome; Adult; Aged; Aged, 80 and over; Arrhythmia, Sinus; Blood Pressure; Cardiovascular Diseases; Electrocardiography; Female; Fingers; Galvanic Skin Response; Humans; Male; Middle Aged; Regional Blood Flow; Sweat Glands; Sweating
PubMed: 8410009
DOI: 10.1136/jnnp.56.10.1096 -
Annals of the Rheumatic Diseases Oct 1990A pure sensory neuropathy caused by lymphocytic infiltration of the dorsal root ganglia has been reported in a few patients with Sjögren's syndrome. The clinical,...
A pure sensory neuropathy caused by lymphocytic infiltration of the dorsal root ganglia has been reported in a few patients with Sjögren's syndrome. The clinical, immunological, and electromyographic findings of five patients with this type of neuropathy and primary Sjögren's syndrome were reviewed. Typical clinical indications were the presence of a chronic asymmetrical sensory deficit, initial disease in the hands with a predominant loss of the vibratory and joint position senses, and an association with Adie's pupil syndrome or trigeminal sensory neuropathy. The simultaneous impairment of the central and peripheral evoked cortical potentials suggested that there was a lesion of the neuronal cell body. The neuropathy preceded the diagnosis of Sjögren's syndrome in four patients. Four patients were positive for Ro antibodies, but systemic vasculitis or malignancy was not found after a mean follow up of six years. These findings indicate that in patients with a sensory neuropathy the diagnosis of Sjögren's syndrome has to be considered, even if the patient denies the presence of sicca symptoms, and that appropriate tests must be carried out.
Topics: Adie Syndrome; Adult; Aged; Antibodies, Antinuclear; Cranial Nerve Diseases; Electromyography; Evoked Potentials, Somatosensory; Female; Humans; Male; Middle Aged; Peripheral Nervous System Diseases; Reflex, Stretch; Sjogren's Syndrome; Trigeminal Nerve
PubMed: 2173499
DOI: 10.1136/ard.49.10.775 -
Journal of Neurology, Neurosurgery, and... Apr 1990
Topics: Adie Syndrome; Carotid Sinus; Female; Humans; Middle Aged; Syndrome; Taste Disorders; Tonic Pupil
PubMed: 2341855
DOI: 10.1136/jnnp.53.4.359 -
The British Journal of Ophthalmology Feb 1984A patient with giant cell arteritis and ischaemic optic neuropathy developed bilateral tonic pupils. This pupillary abnormality may result from ischaemia of the ciliary...
A patient with giant cell arteritis and ischaemic optic neuropathy developed bilateral tonic pupils. This pupillary abnormality may result from ischaemia of the ciliary ganglia. Despite the propensity for patients with giant cell arteritis to develop vascular occlusions in the eye and orbit, tonic pupils have rarely been described, and several reasons for this are proposed. The arteries supplying the ciliary ganglia are frequently involved in giant cell arteritis, but their anastomotic pattern may confer protection from ischaemia. Tonic pupils may also be overlooked amidst the more dramatic manifestations of giant cell arteritis.
Topics: Adie Syndrome; Ciliary Body; Female; Ganglia, Parasympathetic; Giant Cell Arteritis; Humans; Ischemia; Middle Aged
PubMed: 6691957
DOI: 10.1136/bjo.68.2.135 -
Journal of Neurology, Neurosurgery, and... Dec 1980
Topics: Adie Syndrome; Humans; Reflex, Abnormal
PubMed: 7217964
DOI: 10.1136/jnnp.43.12.1147-a -
Journal of Neurology, Neurosurgery, and... Oct 1979The pathophysiological mechanisms underlying benign areflexia were studied in six patients with Holmes-Adie syndrome. No impairment of sensory conduction velocity of...
The pathophysiological mechanisms underlying benign areflexia were studied in six patients with Holmes-Adie syndrome. No impairment of sensory conduction velocity of sural nerve was found. A normal tonic vibration reflex was obtained in all patients. H reflex was absent in five patients, but responses like F waves were recorded in three subjects. These findings suggest that muscle spindles are not affected and that spinal motoneurone excitability is normal.
Topics: Adie Syndrome; Adult; Aged; Electrophysiology; Female; Humans; Male; Middle Aged; Motor Neurons; Neural Conduction; Peripheral Nerves; Reflex, Abnormal; Reflex, Monosynaptic; Vibration
PubMed: 512669
DOI: 10.1136/jnnp.42.10.943 -
British Medical Journal Feb 1979
Topics: Adie Syndrome; Attitude of Health Personnel; Clinical Competence; Educational Measurement; Female; Humans
PubMed: 427422
DOI: 10.1136/bmj.1.6161.488 -
Transactions of the American... 1977Adie's syndrome is a disease of unknown etiology. We known where the damage is, and which nerves are involved. We even know something of how the nerves react after the... (Comparative Study)
Comparative Study
Adie's syndrome is a disease of unknown etiology. We known where the damage is, and which nerves are involved. We even know something of how the nerves react after the damage is done, but we don't known what causes the primary injury. The first step in working a jigsaw puzzle is to getall of the pieces right side up and take a good look at them. Some of the jigsaw pieces handled in this paper are listed below. Some of them are new observations; many of them are old concepts, partly modified and partly made secure by new facts. 1. Not all "tonic pupils" are due to "Adie's syndrome"; some are due to local injury and some to a generalized peripheral neuropathy (Table II). 2. All patients should have serologic tests for shyphilis. In this series one in six had positive serology. 3. The incidence of Adie's syndrome in Iowa in the early 1970's was approximately 4.7 per 100,000 population per year. 4. The prevalence of Adie's syndrome, therefore, was approximately 2 per 1000. 5. The mean age of onset of Adie's syndrome was about 32.2 years (Figure 1A). 6. The sex ratio was 2.6 females to each male. 7. Right eyes and left eyes were involved at approximately the same rate (Figure 2). 8. The incidence of second eye involvement in unilateral cases was about 4% per year during the first decade of the disease (Figure 18). 9. If this rate of second eye involvement (4% per year) persists during subsequent decades, then most Adie's pupils will eventually become bilateral. 10. The incidence of Adie's syndrome in a largely caucasian patient group is independent of iris color (Figure 4). 11. Only 10% of patients with Adie's syndrome had completely normal muscle stretch reflexes. 12. The muscle stretch reflexes in the arms were just as frequently imparied as those in th elegs, but the degree of impariment tended to be more severe in the ankles and triceps. 13. When there was any light reaction remaining in an Adie's pupil, a segmental paralysis of the sphincter muscle could be seen. 14. The near reaction of the pupil was often segmental and frequently involved segments which did not respond to light. 15. The segmental paralysis to light was randomly distributed around the sphincter (Figure 6B). 16. There was some tendency for the sphincter palsy to gradually become worse. This progression was also random (Figure 8). 17. Almost all patients with Adie's syndrome had an accommodative paresis at the time of onset. 18. Reading glasses given to a patient with a fresh Adie's pupil were soon discarded as accommodation recovered (Figure 9). 19. Accomodative effort induced an astigmatism in about half of the eyes with Adie's--presumably the result of a segmental palsy of the ciliary muscle. 20. Tonicity of accommodation was present in about 1/2 of the eyes with Adie's, making it difficut for the patient to maintain a steady level of ciliary muscle tone. 21. An occasional patient complained of brow ache from ciliary spasm with near work. 22. In most patients with Adie's syndrome the ciliary muscle was supersensitive to pilocarpine 0...
Topics: Accommodation, Ocular; Adie Syndrome; Adolescent; Adult; Age Factors; Aged; Child; Child, Preschool; Eye Color; Female; Functional Laterality; Humans; Iris; Male; Middle Aged; Miotics; Mydriatics; Pupil; Reflex, Abnormal; Reflex, Pupillary; Sex Factors
PubMed: 613531
DOI: No ID Found -
The British Journal of Ophthalmology Jul 1975Two cases of tonic pupil, hyporeflexia, and segmental hypohidrosis (Ross' syndrome) are reported. The relationship of this syndrome to other autonomic dysfunction is...
Two cases of tonic pupil, hyporeflexia, and segmental hypohidrosis (Ross' syndrome) are reported. The relationship of this syndrome to other autonomic dysfunction is discussed. Those symptoms (emotional instability, loss of sweating, orthostatic hypotensive symptoms, and signs of bilaterality of the tonic pupil) which should alert the clinician to more extensive disease states are noted. It is suggested that these conditions may represent a continuum or spectrum of disorders with a widespread degree of severity and progression.
Topics: Adie Syndrome; Adult; Affective Symptoms; Diagnosis, Differential; Eye Diseases; Female; Humans; Hypohidrosis; Middle Aged; Pupil; Reflex, Pupillary; Reflex, Stretch; Syndrome; Time Factors
PubMed: 1191625
DOI: 10.1136/bjo.59.7.387 -
Journal of Neurology, Neurosurgery, and... Apr 1975In a patient with Holmes-Adie syndrome, and in another with tabes dorsalis, a transverse cord lesion resulted in a severe, but flaccid paraplegia with absent tendon...
In a patient with Holmes-Adie syndrome, and in another with tabes dorsalis, a transverse cord lesion resulted in a severe, but flaccid paraplegia with absent tendon reflexes. Flexor spasms were severe in both patients, but spasticity was absent. The significance of these observations is discussed in relation to the functional and anatomical disorder in these two syndromes.
Topics: Adie Syndrome; Aged; Female; Gait; H-Reflex; Humans; Male; Middle Aged; Paraplegia; Postoperative Complications; Radiography; Reflex, Stretch; Spasm; Spinal Cord; Spinal Cord Compression; Tabes Dorsalis
PubMed: 1141918
DOI: 10.1136/jnnp.38.4.317