[Pupillary abnormalities in a patient with clinically diagnosed corticobasal degeneration]

We report a 65-year-old woman, who suffered from clumsiness of the left hand for 6 years. Gait disturbance, body balance impairment and rigidity of the left arm appeared progressively. Anti-parkinsonian drugs such as 1-dopa, doroxidopa, amantadine and bromocriptine were ineffective. Magnetic resonance imaging showed brain atrophy, especially in the right fronto-parietal lobes. Positron emission tomography (18F-fluoro-2-deoxy-D-glucose) showed decreased glucose metabolism in the right cerebral cortex, putamen and thalamus. A diagnosis of corticobasal degeneration was made, based on the clinical manifestations, MRI and PET findings. She also showed anisocoria, vertical gaze palsy and abnormal pupillary reactions. Her left pupil showed an oval figure shifted from the center position. The pupils exhibited denervation supersensitivity in the 0.125% pilocarpine test. We consider that her pupillary abnormalities may be related to her midbrain lesion (midbrain corectopia) associated with corticobasal degeneration.