The Argyll Robertson pupillary syndrome; mechanism and localization.
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This study was designed to compare brightness contributions of the two monocular inputs to the binocular visual system at three different levels of luminance adaptation in two groups of 15 subjects each. The only known difference between these groups was stereothreshold, 50 to 70 sec arc in one group vs. 40 sec arc or less in the other group. The group with elevated threshold was found to have a significantly larger average difference (13.5%, p less than 0.002) in monocular brightness contributions, between the right and left eyes, when compared to the group with lower stereothresholds (4% mismatch). The results also indicate that neither group showed a significant variation in mismatch as adapting luminance was altered by a factor of four times (0.6 log units). Finally, no clear relation was found between eye dominance and the eye requiring higher illuminance to attain the dichoptic brightness match.
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A patient with paralysis of upward gaze and downward gaze, absent oculocephalic reflexes, and absent vertical saccades also demonstrated intermittent stupor over the first 9 days of presentation. Magnetic resonance imaging (MRI) demonstrated an infarct in the tegmentum of the mesencephalon including the right red nucleus and the periaqueductal area, superior to the oculomotor nucleus, and contiguous through the left thalamus. The infarct included the area around the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF), as well as the midbrain reticular formation. Mechanisms are proposed for the unusual concurrent sign of intermittent unresponsiveness in this case.
Fourteen pupils of the New Hope School in Pretoria who were considered to be responsive to methylphenidate were randomised to receive either the active drug or placebo in a double-blind trial for each of 4 weeks. Their behaviour was monitored by parents and teachers, who were required to complete a questionnaire (Conner's Abbreviated Teachers' Rating Scale) three times per week. After analysis of the data, only 2 children were identified as methylphenidate responders and 1 as a probable responder. One child showed significant deterioration on the drug while another showed deterioration that approached significance. The remaining 9 exhibited no significant response to methylphenidate.
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