Parasympathetic pupillary involvement in biopsy-proven temporal arteritis

The neuro-ophthalmologic spectrum of temporal arteritis (TA) is broad and includes such diverse presentations as ischemic optic neuropathy, retinal infarction, anterior ocular segment dysfunction, ophthalmoparesis, and cortical blindness. A common clinical dictum suggests that third nerve palsies are associated with pupillary sparing in this systemic arteritis. We present a biopsy-proven case of TA with parasympathetic pupillary involvement and ophthalmoparesis. Relative light-near dissociation and differential clinical response to adrenocorticosteroids occurred. Previous pathologic studies have suggested that clinically apparent parasympathetic pupillary dysfunction could follow arteritic lesions at several neuroanatomic sites and may, therefore, reflect different pathogenetic mechanisms and display distinctive clinical features. Our case effectively broadens the clinicopathologic locus of neuro-ophthalmologic expression in TA.