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Oculosympathetic Spasm With Cervical Spinal Cord Injury

Oculosympathetic Spasm With Cervical Spinal Cord Injury Abstract • A 23-year-old man, involved in a motor-vehicle accident, became quadraparetic due to cervical spinal cord injury at the C-4 to C-6 level. Five months later he was noted to have bilateral, asymmetric pupillary mydriasis precipitated by elevation and stretch of an arm or leg. Pharmacologic pupillary testing and ciliospinal reflex responses suggested that the oculosympathetic pathways were intact. Computed tomographic myelography using metrizamide disclosed a posttraumatic syringomyelic cyst at C-4. This pupillary phenomenon has been termed oculosympathetic spasm, and we reviewed four previous reports. While the cause of oculosympathetic spasm remains speculative, it may represent a localized form of autonomic hyperreflexia. References 1. Lowenstein O, Levine AS: Periodic sympathetic spasm and relaxation and role of sympathetic nervous system in pupillary innervation . Arch Ophthalmol 1944;31:74-94.Crossref 2. Kramer W, van der Does de Willebois JJM: Occlusion of the anterior spinal artery in the cervical cord with sympathetic spasm of the pupil on finger movement . Folia Psychiatr Neurol 1959;62:458-464. 3. Grissiord A, Held JP, Odievre M, et al: Mydriase par excitation nociceptive sous lésionnelle chez les tétrapléquies . Rev Neurol 1961;104:310-314. 4. Buscaino GA, Sanna G: Patologia neuromuscolare insolita: IV. Su di un caso di sindrome irritativa accessuale motorio-oculosimpatica (spasmo della mano e midriasi omolaterale intermittente da lesione intramidollare) . Acta Neurol 1972;27:321-339. 5. Herman P: Ocular dysfunction resulting from spinal cord injuries , in Vinken PJ, Bruyn GW (eds): Handbook of Clinical Neurology . Amsterdam, North-Holland Publishing Co, 1976, vol 24, pp 381-389. 6. Arieff AJ, Pyzik SW: The ciliospinal reflex in injuries of the cervical spinal cord in man . Arch Neurol 1953;70:621-629.Crossref 7. Grimson BS, Thompson HS: Drug testing in Horner's syndrome , in Glaser JS, Smith JL (eds): Neuro-ophthalmology: Symposium of the University of Miami . St Louis, CV Mosby Co, 1975, vol 8, pp 265-269. 8. Thompson HS: Diagnosing Horner's syndrome . Trans Am Acad Ophthalmol Otolaryngol 1977;83:840-842. 9. Crosby EC, Humphrey T, Lauer EW: Correlative anatomy of the nervous system . New York, Macmillan Publishing Co Inc, 1962, pp 102, 232-234. 10. Kerr FWL, Brown JA: Pupillomotor pathways in the spinal cord . Arch Neurol 1964;10:262-270.Crossref 11. Walsh FB, Hoyt WF: Clinical Neuro-ophthalmology . Baltimore, Williams & Wilkins Co, 1969, pp 475-480. 12. Foerster O, Gagel O: Die Vorderseiten-strang durchschneidung beim Menschen . Z Neurol Psychiatr 1932;138:1-92.Crossref 13. Kurnicle NB: Autonomic hyperreflexia and its control in patients with spinal cord lesions . Ann Intern Med 1956;44:678-686.Crossref 14. Erickson RP: Autonomic hyperreflexia: Pathophysiology and medical management . Arch Phys Med Rehabil 1980;61:431-439. 15. McGarry J, Woolsey RM, Thompson CW: Autonomic hyperreflexia following passive stretching to the hip joint . Phys Med 1982;62:30-31. 16. Wayne EM, Vukov JG: Eye findings in autonomic hyperreflexia . Ann Ophthalmol 1977;9:41-42. 17. Kewalramani LS: Autonomic dysreflexia in traumatic myelopathy . Am J Phys Med 1980;59:1-21. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Oculosympathetic Spasm With Cervical Spinal Cord Injury

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Publisher
American Medical Association
Copyright
Copyright © 1984 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1984.04050130067025
Publisher site
See Article on Publisher Site

Abstract

Abstract • A 23-year-old man, involved in a motor-vehicle accident, became quadraparetic due to cervical spinal cord injury at the C-4 to C-6 level. Five months later he was noted to have bilateral, asymmetric pupillary mydriasis precipitated by elevation and stretch of an arm or leg. Pharmacologic pupillary testing and ciliospinal reflex responses suggested that the oculosympathetic pathways were intact. Computed tomographic myelography using metrizamide disclosed a posttraumatic syringomyelic cyst at C-4. This pupillary phenomenon has been termed oculosympathetic spasm, and we reviewed four previous reports. While the cause of oculosympathetic spasm remains speculative, it may represent a localized form of autonomic hyperreflexia. References 1. Lowenstein O, Levine AS: Periodic sympathetic spasm and relaxation and role of sympathetic nervous system in pupillary innervation . Arch Ophthalmol 1944;31:74-94.Crossref 2. Kramer W, van der Does de Willebois JJM: Occlusion of the anterior spinal artery in the cervical cord with sympathetic spasm of the pupil on finger movement . Folia Psychiatr Neurol 1959;62:458-464. 3. Grissiord A, Held JP, Odievre M, et al: Mydriase par excitation nociceptive sous lésionnelle chez les tétrapléquies . Rev Neurol 1961;104:310-314. 4. Buscaino GA, Sanna G: Patologia neuromuscolare insolita: IV. Su di un caso di sindrome irritativa accessuale motorio-oculosimpatica (spasmo della mano e midriasi omolaterale intermittente da lesione intramidollare) . Acta Neurol 1972;27:321-339. 5. Herman P: Ocular dysfunction resulting from spinal cord injuries , in Vinken PJ, Bruyn GW (eds): Handbook of Clinical Neurology . Amsterdam, North-Holland Publishing Co, 1976, vol 24, pp 381-389. 6. Arieff AJ, Pyzik SW: The ciliospinal reflex in injuries of the cervical spinal cord in man . Arch Neurol 1953;70:621-629.Crossref 7. Grimson BS, Thompson HS: Drug testing in Horner's syndrome , in Glaser JS, Smith JL (eds): Neuro-ophthalmology: Symposium of the University of Miami . St Louis, CV Mosby Co, 1975, vol 8, pp 265-269. 8. Thompson HS: Diagnosing Horner's syndrome . Trans Am Acad Ophthalmol Otolaryngol 1977;83:840-842. 9. Crosby EC, Humphrey T, Lauer EW: Correlative anatomy of the nervous system . New York, Macmillan Publishing Co Inc, 1962, pp 102, 232-234. 10. Kerr FWL, Brown JA: Pupillomotor pathways in the spinal cord . Arch Neurol 1964;10:262-270.Crossref 11. Walsh FB, Hoyt WF: Clinical Neuro-ophthalmology . Baltimore, Williams & Wilkins Co, 1969, pp 475-480. 12. Foerster O, Gagel O: Die Vorderseiten-strang durchschneidung beim Menschen . Z Neurol Psychiatr 1932;138:1-92.Crossref 13. Kurnicle NB: Autonomic hyperreflexia and its control in patients with spinal cord lesions . Ann Intern Med 1956;44:678-686.Crossref 14. Erickson RP: Autonomic hyperreflexia: Pathophysiology and medical management . Arch Phys Med Rehabil 1980;61:431-439. 15. McGarry J, Woolsey RM, Thompson CW: Autonomic hyperreflexia following passive stretching to the hip joint . Phys Med 1982;62:30-31. 16. Wayne EM, Vukov JG: Eye findings in autonomic hyperreflexia . Ann Ophthalmol 1977;9:41-42. 17. Kewalramani LS: Autonomic dysreflexia in traumatic myelopathy . Am J Phys Med 1980;59:1-21.

Journal

Archives of NeurologyAmerican Medical Association

Published: Jan 1, 1984

References