Abstract
A 16-year-old girl suffered a severe head trauma with paralyses of the right oculomotor, trochlear, and abducens nerves. Three years later, only the abducens nerve had recovered. The pupil did not react to light or near. However, the diameter of the pupil correlated with horizontal gaze: with the gaze to the left, the diameter of the pupil was 8 mm, with the gaze straight ahead, 6 mm, and with the gaze to the right, 4 mm. With saccades to the right, the pupil started to constrict immediately and reached its smallest diameter after about 2 s. We conclude that the constriction of the pupil was due to misdirected regeneration of abducens nerve neurons into the parasympathetic pathway of the oculomotor nerve.
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References
Bach L (1904) Pupillenstudien. Graefe's Arch Clin Exp Ophthalmol 57:219–265
Behr C (1921) Zur Klinik der pathologischen Mitbewegung der Pupille. Klin Monatsbl Augenheilkd 67:369–380
Bielschowsky A (1904) Demonstration eines ungewöhnlichen Pupillenphänomens. Munch Med Wochenschr 51:538–539
Blatt N (1922) Zur Frage des „Abduktionsphänomens”. Klin Monatsbl Augenheilkd 69:735–742
Czarnecki JSC, Thompson HS (1978) The iris sphincter in aberrant regeneration of the third nerve. Arch Ophthalmol 96:1606–1610
Ford FR, Woodhall B (1938) Phenomena due to misdirection of regenerating fibers of cranial, spinal and autonomic nerves: Clinical observations. Arch Surg 36:480–496
Graefe A von (1857) Beobachtungen über das Verhalten der Pupille bei gewissen Oculomotorius-Lähmungen. Arch Ophthalmol 3:363–365
Jordan DR, Miller DG, Anderson RL (1990) Acquired oculomotor-abducens synkinesis. Can J Ophthalmol 25:148–151
Kramer (1922) Abductionsreaktion der Pupille. Dtsch Med Wochenschr 48:1327
Lipschütz B [In: Behr C (1921) Zur Klinik der pathologischen Mitbewegung der Pupille. Klin Monatsbl Augenheilkd 67:369–380]
Pietruschka G, Stumpf W (1957) Über einen Fall mit sehr seltenen Pupillenstörungen. Graefe's Arch Clin Exp Ophthalmol 159:420–432
Ramo y Cajal S (1928) Degeneration and regeneration of the nervous system. Raoul M. May (transl and ed) Oxford University Press, London
De Rosa G (1927) Considerazioni sul reflesso del Tournay. [In: Zentralbl Ophthalmol 18:459–460] Arch di Ottalmol 33:12:538–544
Salus R (1923) Zur Frage der Mithewegungen der Pupille. Klin Monatsbl Augenheilkd 71:289–305
Samelsohn (1884) Seltenere Beobachtungen zur Semiotik der Pupillarreaction. Dtsch Med Wochenschr 20:91
Weiss L (1875) Zur Bestimmung des Drehpunktes im Auge. Arch Ophthalmol 21:132–186
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A video tape of this case was demonstrated at the VIIIth Congress of the International Neuro-ophthalmological Society in Winchester, UK, 27 June, 1990
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Pfeiffer, N., SimonS, H.J. & Kommerell, G. Misdirected regeneration of abducens nerve neurons into the parasympathetic pupillary pathway. Graefe's Arch Clin Exp Ophthalmol 230, 150–153 (1992). https://doi.org/10.1007/BF00164653
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DOI: https://doi.org/10.1007/BF00164653