Adie syndrome: Difference between revisions

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== Diagnosis ==
== Diagnosis ==
===Diagnostic Criteria===
===Diagnostic Criteria===
*The diagnosis of [[adie syndrome] is made when both pupillary abnormalities and absence or impairment of [[deep tendon reflexes]] is present. Although, both of these features may not coexist. If only pupillary abnormalities are present then the condition is referred to as [[adie pupil]].
*The diagnosis of [[adie syndrome] is made when both pupillary abnormalities and absence or impairment of [[deep tendon reflexes]] are present. Although, both of these features may not coexist. If only pupillary abnormalities are present then the condition is referred to as [[adie pupil]].


=== History and Symptoms ===
=== History and Symptoms ===

Revision as of 11:24, 1 September 2020


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ahmad Muneeb, MBBS[2] Synonyms and keywords: Holmes-Adie Syndrome; Syndrome, Holmes-Adie; Syndrome, Adie's; Syndrome, Adie; Poorly Reacting Pupil; Holmes Adie Syndrome; Pupil, Poorly Reacting; Adie's Syndrome; Poorly Reacting Pupils; Pupils, Poorly Reacting

Overview

Adie syndrome is characterized by abnormal pupillary function and loss of deep tendon reflexes. Abnormal pupillary functioning in adie syndrome involves poor pupillary response to light but a better near response (light near dissociation). Damage to ciliary ganglion is responsible for pupillary abnormalities while the loss of deep tendon reflexes is caused by damage to dorsal root ganglion of spinal cord. Most of the times the cause of Adie syndrome is unknown, however, multiple pathologies can cause adie syndrome. It is a benign condition and is mostly diagnosed clinically.

Historical Perspective

Classification

Pathophysiology

Causes

Most commonly the cause of Adie syndrome is unknown(idiopathic). Less common causes of adie syndrome include infections like HIV[4], syphilis[5], varicella, lyme's disease[6], Human parvovirus-B19, autoimmune diseases like amyloidosis, sarcoidosis, guillain-barre syndrome, sjogren syndrome, polyarterities nodosa[7], vogt-koyanagi-haraga disease[8], ischemia caused by giant cell arteritis[9], migraine[10], lymphatoid granulomatosis, neuromuscular diseases like Lambert eaten syndrome[11], tumors affecting the orbit or choroid[12], orbital surgery[13], cardiovascular diseases[14], general anesthesia[15]. ,anti-hu antibody[16].

Differentiating adie syndrome from other Diseases

Epidemiology and Demographics

  • The prevalence of adie syndrome is approximately 2 per 1000 individuals. [2]
  • The annual incidence of adie syndrome is estimated to be [4.7] cases per 100,000 individuals. [2]

Age

Gender

Race

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

  • The diagnosis of [[adie syndrome] is made when both pupillary abnormalities and absence or impairment of deep tendon reflexes are present. Although, both of these features may not coexist. If only pupillary abnormalities are present then the condition is referred to as adie pupil.

History and Symptoms

Physical Examination

  • Physical examination may be remarkable for:

Laboratory Findings

  • There are no specific laboratory findings associated with adie syndrome.

Electrocardiogram

There are no ECG findings associated with adie syndrome.

X-ray

There are no x-ray findings associated with adie syndrome.

Echocardiography or Ultrasound

There are no echocardiography/ultrasound findings associated with adie syndrome.

CT scan

There are no CT scan findings associated with adie syndrome.

MRI

There are no MRI findings associated with adie syndrome.

Other Imaging Findings

There are no other imaging findings associated with adie syndrome.

Other Diagnostic Studies

Low dose pilocarpine test may be helpful in the diagnosis adie syndrome. Finding suggestive of adie pupil includes an exaggerated miotic reaction of the affected pupil as compared to the normal pupil. This exaggerated response to low dose pilocarpine occurs as a consequence of cholinergic denervation hypersensitivity of the affected pupil. Normal pupils do not respond to such low doses of pilocarpine. To rule out Ross syndrome, sweating abnormalities can be checked by using starch iodine test and spoon test.

Treatment

Medical Therapy

Surgery

Prevention

  • There are no primary preventive measures available for adie syndrome.

References

  1. Thompson HS (1977). "Adie's syndrome: some new observations". Transactions of the American Ophthalmological Society. 75: 587–626. PMC 1311565. PMID 613531.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 Sarao MS, Elnahry AG, Sharma S. "Adie Syndrome (Tonic Pupil Syndrome) Article - StatPearls".
  3. Agbeja AM, Dutton GN (1987). "Adie's syndrome as a cause of amblyopia". Journal of Pediatric Ophthalmology and Strabismus. 24 (4): 176–7. PMID 3668764.
  4. Cerny R, Rozsypal H, Kozner P, Machala L (October 2010). "Bilateral Holmes-Adie syndrome as an early manifestation of the HIV neuropathy". Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. 31 (5): 661–3. doi:10.1007/s10072-010-0355-9. PMID 20567990.
  5. Sakai T, Shikishima K, Mizobuchi T, Yoshida M, Kitahara K (2003). "Bilateral tonic pupils associated with neurosyphilis". Japanese Journal of Ophthalmology. 47 (4): 368–71. doi:10.1016/s0021-5155(03)00058-3. PMID 12842205.
  6. Stricker RB, Winger EE (March 2001). "Holmes-Adie syndrome and Lyme disease". Lancet (London, England). 357 (9258): 805. doi:10.1016/S0140-6736(05)71234-4. PMID 11254002.
  7. Bennett JL, Pelak VA, Mourelatos Z, Bird S, Galetta SL (1999). "Acute sensorimotor polyneuropathy with tonic pupils and an abduction deficit: an unusual presentation of polyarteritis nodosa". Survey of Ophthalmology. 43 (4): 341–4. doi:10.1016/s0039-6257(98)00047-2. PMID 10025516.
  8. Garza Leon M, Herrera-Jimenez IP, González-Madrigal PM (August 2014). "Complete Vogt-Koyanagi-Harada disease and Holmes-Adie syndrome: case report". Ocular Immunology and Inflammation. 22 (4): 336–40. doi:10.3109/09273948.2013.848906. PMID 24215593.
  9. Foroozan R, Buono LM, Savino PJ, Sergott RC (April 2003). "Tonic pupils from giant cell arteritis". The British Journal of Ophthalmology. 87 (4): 510–2. doi:10.1136/bjo.87.4.510. PMC 1771609. PMID 12642330.
  10. Purvin VA (March 1995). "Adie's tonic pupil secondary to migraine". Journal of Neuro-ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society. 15 (1): 43–4. PMID 7780572.
  11. Wirtz PW, de Keizer RJ, de Visser M, Wintzen AR, Verschuuren JJ (March 2001). "Tonic pupils in Lambert-Eaton myasthenic syndrome". Muscle & Nerve. 24 (3): 444–5. doi:10.1002/1097-4598(200103)24:3<444::aid-mus1021>3.0.co;2-w. PMID 11353435.
  12. Goldstein SM, Liu GT, Edmond JC, Katowitz JA, Rorke LB (February 2002). "Orbital neural-glial hamartoma associated with a congenital tonic pupil". Journal of AAPOS : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus. 6 (1): 54–5. doi:10.1067/mpa.2002.120171. PMID 11907481.
  13. Stromberg BV, Knibbe M (November 1988). "Anisocoria following reduction of bilateral orbital floor fractures". Annals of Plastic Surgery. 21 (5): 486–8. doi:10.1097/00000637-198811000-00016. PMID 3232939.
  14. Guaraldi P, Mathias CJ (September 2011). "Progression of cardiovascular autonomic dysfunction in Holmes-Adie syndrome". Journal of Neurology, Neurosurgery, and Psychiatry. 82 (9): 1046–9. doi:10.1136/jnnp.2009.195917. PMID 20562402.
  15. Kobayashi M, Takenami T, Kimotsuki H, Mukuno K, Hoka S (February 2008). "Adie syndrome associated with general anesthesia". Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 55 (2): 130–1. doi:10.1007/BF03016329. PMID 18245077.
  16. Zhang L, Luo S, Jin H, Lv X, Chen J (2019). "Anti-Hu Antibody-Associated Adie's Pupil and Paraneoplastic Sensorimotor Polyneuropathy Caused by Primary Mediastinal Small Cell Carcinoma". Frontiers in Neurology. 10: 1236. doi:10.3389/fneur.2019.01236. PMC 6901962 Check |pmc= value (help). PMID 31849812.
  17. Thompson HS, Kardon RH (June 2006). "The Argyll Robertson pupil". Journal of Neuro-ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society. 26 (2): 134–8. doi:10.1097/01.wno.0000222971.09745.91. PMID 16845316.
  18. Shin RK, Galetta SL, Ting TY, Armstrong K, Bird SJ (December 2000). "Ross syndrome plus: beyond horner, Holmes-Adie, and harlequin". Neurology. 55 (12): 1841–6. doi:10.1212/wnl.55.12.1841. PMID 11134383.
  19. Martin TJ (February 2018). "Horner Syndrome: A Clinical Review". ACS Chemical Neuroscience. 9 (2): 177–186. doi:10.1021/acschemneuro.7b00405. PMID 29260849.

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