Papillary Syn?ploins. — Fixed pupil lary contraction (spinal myosis); a loss, abruptly, or gradually progressive, of the reflex action to light; accommodation to distance and in convergence being pre served (reflex iridoplegia, Argyll-Robert son pupil) with loss of the sympathetic skin-reflex, are the more constant and characteristic pupillary abnormalities in tabes. Both eyes are usually affected and to about the same degree. The iridoplegia may be unilateral, however; and the two pupils may be unequally contracted or one only may be abnor mally small. Permanent mydriasis or dilatation has been rarely observed.
The Argyll-Robertson pupil is, per haps, the most constant and characteris tic symptom in posterior spinal sclerosis. It is also an early symptom invariably, and in combination with abolished knee jerks affords sufficient data for diagnosis even in the absence of all other symp toms. In late tabes the action of the pupils in accommodation is also lost.
Case of man suffering from tabes dor salis, who, when examined in 1S96, had the characteristic signs of the disease, with the exception that the pupils re acted both to light and in accommoda tion. Four months later the symptoms were still more pronounced, and the pupils failed to react either to light or in accommodation. This condition con tinued for nearly a year, when it was found that the pupils reacted well to light and continued so to react for the remainder of the period during which the patient was under observation. The case illustrates improvement in the pupillary symptoms, while the general symptoms grew worse. Treupel (Miinchener med. Woeh., Aug. 30, '93).
TWO eases of intermittent Argyll Robertson pupil in tabes dorsalis. Both patients were W0/13C11 33 years of age. In both eases there were evidences of syphi lis, and the symptoms of tabes were plain. The pupil reflexes varied under continued observation and notwithstanding steady progress of the disease. Eiehhorst (Deut. med. Woch., No. 23, '96).
The lesion in Argyll-Robertson pupil is probably in the fibres which pass frorn the proximal end of the optic nerve to the oculomotor nerve, according to de Schweinitz, who quotes Turner, how ever, as believing that a single lesion in the forepart of the oculomotor nuclei in the Sylvian gray as the cause of both myosis and reflex iridoplegia.
Optic Atrophy.— This symptom may occur at any stage, though usually it is present in early tabes. It has been found in from 10 to 35 per cent. of cases ac cording to the observer. Bergur found it present in 44 of 109 cases. Disturb ances of color-sense and contraction of the visual field are associated phenom ena. The progress of the atrophy is
usually slow, and remissions may occur. Blindness ensues in from three to five years. The ataxia and also the painful sensory symptoms diminish upon the onset of blindness, as a rule (amaurotic tabes). The left eye is said to be at tacked oftener than the right. Both eyes are usually involved. however.
The onset of optic neuritis in the early stage of tabes is followed by improve ment in other symptoms, and retards or arrests the further course of the disease. Martin (Neurol. Centralb., Oct. 1, '90).
Five cases of tabes in which atrophy of the optic nerve preceded the usual symptoms of tabes during a long period (up to twenty-five years). Howell Persh ing (Med. Nem s, :Mar. 26, '92).
The specific motor symptonis in tabes begin to disappear as soon as atrophy of the optic nerve sets in. I3enedikt (La Med. Mod., Mar. 20, '95).
In about 75 per cent. of the cases of tabes, in which optic atrophy is an early symptom, some of the other tabetic symp toms may be late in appearing or may not develop at all. This is especially the ease in respect to the lightning pains and the inco-ordination of movement. The loss of knee-jerk in such eases is very constant.
The most distressing symptoms may develop shnultaneously with or immedi ately succeed the blindness.
The association with the optic atrophy of oculomotor palsies is without prognos tic significance. Pearce liailey (Med. Rec., Nov. 14, '90).
Ophthalmoscopically the optic atrophy of posterior spinal sclerosis presents the appearance of primary degenerative at rophy in contrast to the appearance in that form which follows neuritis.
Ocular-Muscle Palsies. — One of the first symptoms in locomotor ataxia may be an attack of double vision with or without ptosis. Occurring in the early stages of the disease, such attacks are usually of abrupt onset and transitory duration, disappearing completely in a few days or weeks. Well-marked strabis mus, most commonly of the variety due to sixth-nerve involvement, may be pres ent, and, if an early symptom, is equally abrupt in onset and transient in dura tion. Mains believes that sudden pain less ocular palsies in an adult are almost pathognomonic of tabes. They are cer tainly exceedingly suggestive. Ptosis, more or less decided, is frequently noted in late stages of posterior spinal sclerosis. Such ptosis is usually of slow progressive development and remains permanent. This is true, also, of strabismus. Oph thalmoplegia, both external and internal, has been sometimes observed, though with decided infreqnency.