Pupillenreflexst�rungen bei L�sionen der oberen Sehbahn

Abstract

In six patients with ischemic lesions of the visual pathways above the lateral geniculate body, the pupil light reflex was investigated under perimetric conditions. The size of the lesions--in four cases caused by lateralized cerebral infarction, in two cases by complicated migraine attacks--was certified by neurological examination and by angiography or computerized tomography respectively. The recordings were done with a portable pupillograph measuring the infrared light reflected from the iris. A Tübinger perimeter served as stimulator. All patients except one, whose visual fields recovered quickly and completely, showed parallel tracings concerning the sensory and the pupillographic profiles, in the older lesions as well as in the recent ones.

Pupil campimetry in patients with visual field loss

“…It has to be differentiated if the underlying lesion involves retrogeniculate structures or the anterior visual pathway and herewith the traditional PLR arc. Several studies in the past have provided evidence for an impairment of pupil responses to small localized stimuli registered by pupillography also in patients with pure retrogeniculate damage (Bresky and Charles, 1969;Harms et al, 1973;Cibis et al, 1975;Hellner et al, 1978;Alexandridis et al, 1979;Hamann et al, 1979;Kardon, 1992). Our study confirms these findings in most of the patients.…”

Neuro-ophthalmology of pupillary function - practical guidelines

“…This is not the only finding incompatible with classical models. Pupillary hemiakinesia in occipital lesions as it was convincingly shown by several authors should be impossible, if we imply a direct retinal-pretectal connection [1,7,17,24]. The finding of a contralateral RAPD on occlusion of one eye is of practical importance.…”

How sensitive is pupil campimetry in hemifield loss?

“…Studies in patients with retrogeniculate damage have provided good evidence for an impairment of pupil responses to small localized stimuli registered by pupillography [4][5][6][7][8][9][10][11][12][13]. Early clinical reports [4][5][6][7] were later reproduced by other groups using modern pupillometric techniques in patients well-documented by magnetic resonance imaging or computed tomography [8][9][10][11][12][13], and currently there is no doubt that the retrogeniculate visual pathway or even visual cortex is involved in the pupillary light reaction, and our results support those findings. Astonishingly, in our study the retrogeniculate lesions could be better reproduced than pregeniculate by pupil perimetry.…”

“…However, many reports in the literature [4][5][6][7][8][9][10][11][12][13] provide strong evidence that patients with isolated occipital lesions and homonymous visual field defects show corresponding pupil defects to focal light presented to the same area. The published findings provide compelling evidence for a role of cortical processing of the pupillary light reflex under certain stimulus conditions.…”