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Parasympathetic pupillary involvement in biopsy-proven temporal arteritis
1Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461.
Annals of Ophthalmology
|October 1, 1988
Summary
Temporal arteritis (TA) can affect the nervous system and eyes in various ways. This case shows TA can cause pupil abnormalities, broadening our understanding of its neuro-ophthalmic effects.
Area of Science:
- Ophthalmology
- Neurology
- Rheumatology
Background:
- Temporal arteritis (TA), a systemic vasculitis, commonly presents with diverse neuro-ophthalmic manifestations.
- Typical presentations include ischemic optic neuropathy, retinal infarction, and ophthalmoparesis.
- A common clinical belief is that third nerve palsies in TA spare the pupil.
Observation:
- This study details a biopsy-proven case of TA presenting with both ophthalmoparesis and parasympathetic pupillary dysfunction.
- The patient exhibited relative light-near dissociation and a variable response to corticosteroid treatment.
- This contrasts with the typical expectation of pupillary sparing in TA-associated third nerve palsies.
Findings:
- The case demonstrates that TA can involve parasympathetic pathways controlling the pupil, challenging the dictum of pupillary sparing.
- Pathological studies suggest parasympathetic dysfunction in TA can arise from lesions at various neuroanatomic sites.
- These different sites may indicate distinct pathogenetic mechanisms and clinical presentations.
Implications:
- This case expands the known clinicopathologic spectrum of neuro-ophthalmic involvement in temporal arteritis.
- It highlights the importance of considering parasympathetic dysfunction in the differential diagnosis of TA.
- Understanding these varied presentations is crucial for accurate diagnosis and effective management of TA.