Pupillographic investigation of the relative afferent pupillary defect associated with a midbrain lesion

Aki Kawasaki; Neil R Miller; Randy Kardon

doi:10.1016/j.ophtha.2009.06.053

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Pupillographic investigation of the relative afferent pupillary defect associated with a midbrain lesion

Journal article

Open access

Peer reviewed

Pupillographic investigation of the relative afferent pupillary defect associated with a midbrain lesion

Aki Kawasaki, Neil R Miller and Randy Kardon

Ophthalmology (Rochester, Minn.), Vol.117(1), pp.175-179

01/2010

DOI: 10.1016/j.ophtha.2009.06.053

PMID: 19923003

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Abstract

To identify clinical and pupillographic features of patients with a relative afferent pupillary defect (RAPD) without visual acuity or visual field loss caused by a lesion in the dorsal midbrain. Experimental study. Four patients with a dorsal midbrain lesion who had normal visual fields and a clinically detectable RAPD. The pupil response from full-field and hemifield light stimulation over a range of light intensities was measured by computerized binocular pupillography. The mean of the direct and consensual pupil response to full-field and hemifield light stimulation was plotted as a function of stimulus light intensity. All 4 subjects showed decreased pupillographic responses at all intensities to full-field light stimulation in the eye with the clinical RAPD. The pupillographic responses to hemifield stimulation showed a homonymous pattern of deficit on the side ipsilateral to the RAPD, similar to that observed in a previously reported patient with an optic tract lesion. The basis of a midbrain RAPD is the nasal-temporal asymmetry of pupillomotor input that becomes manifest when a unilateral postchiasmal lesion interrupts homonymously paired fibers traveling in the contralateral optic tract or midbrain pathway to the pupillomotor center, respectively. The pupillographic characteristics of an RAPD resulting from a dorsal midbrain lesion thus resemble those of an RAPD resulting from a unilateral optic tract lesion, but without the homonymous visual field defect. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Pupil Disorders - diagnosis

Pupil Disorders - etiology

Humans

Middle Aged

Brain Injuries - complications

Visual Acuity

Brain Stem Infarctions - complications

Brain Injuries - diagnosis

Astrocytoma - complications

Pupil - radiation effects

Visual Fields

Light

Pinealoma - complications

Adolescent

Pinealoma - diagnosis

Adult

Aged

Brain Stem Infarctions - diagnosis

Photic Stimulation

Astrocytoma - diagnosis

Diagnostic Techniques, Ophthalmological

Details

Title: Subtitle: Pupillographic investigation of the relative afferent pupillary defect associated with a midbrain lesion
Creators: Aki Kawasaki - Hôpital Ophtalmique Jules Gonin, Lausanne, Switzerland
Neil R Miller
Randy Kardon
Resource Type: Journal article
Publication Details: Ophthalmology (Rochester, Minn.), Vol.117(1), pp.175-179
DOI: 10.1016/j.ophtha.2009.06.053
PMID: 19923003
NLM abbreviation: Ophthalmology
ISSN: 0161-6420
eISSN: 1549-4713
Publisher: United States
Grant note: DOI: 10.13039/100001818, name: Research to Prevent Blindness; DOI: 10.13039/501100001711, name: Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung, award: 32 66319.01; DOI: 10.13039/100000738, name: U.S. Department of Veterans Affairs
Language: English
Date published: 01/2010
Academic Unit: Iowa Neuroscience Institute; Ophthalmology and Visual Sciences
Record Identifier: 9983980286302771

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