Tonic pupils: an unusual autonomic involvement in chronic inflammatory demyelinating polyneuropathy (CIDP)

Escorcio‐Bezerra, Marcio Luiz; Manzano, Gilberto Mastrocola; Bichuetti, Denis Bernardi; Nunes, Karlo Faria; Correa, Daniele Sales Alves; Oliveira, Acary Souza Bullé; Baeta, Alex Machado

doi:10.1007/s10072-019-03890-8

Cited by 6 publications

(5 citation statements)

References 9 publications

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“… 17 , 20 In the context of CIDP, an autonomic dysfunction has been described only in rare cases; therefore, a CSA increase of the vagus nerve compared to controls was not expected. 36 …”

Section: Discussionmentioning

confidence: 99%

Vagal cross-sectional area correlates with parasympathetic dysfunction in Parkinson's disease

Huckemann

Mueller

Averdunk

et al. 2022

Brain Communications

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The aim of this prospective study was to investigate autonomic function in Parkinson’s disease with a multidimensional approach including clinical evaluation tools, head-up tilt test and morphological studies of the vagus nerve. Head-up tilt test parameters including high frequency power of the heart frequency interval, the ratio of low frequency power of the distance between two consecutive R waves in electrocardiogram (RR interval) to the high frequency and low frequency power of systolic blood pressure were used to evaluate parasympathetic, cardiac sympathetic and vasomotor sympathetic functions, respectively in 80 patients with Parkinson´s disease. We examined the cross-sectional area of the vagus nerves bilaterally using nerve ultrasound and compared mean values with a control group of healthy subjects (n=40) as well as patients with chronic inflammatory demyelinating polyneuropathy (n= 76). The cross-sectional area of right/left vagus nerve of Parkinson´s patients was significantly lower compared to the right/left vagus nerve of the control group and of chronic demyelinating polyneuropathy patients. Furthermore, the cross-sectional area of the right vagus nerve was significantly larger from the one of the left vagus nerve for all groups. Based on tilt test, 43 patients (disease duration 7 ± 5, age at evaluation 71 ± 9, Hoehn & Yahr score 2.8 ± 8) were diagnosed with autonomic dysfunction (orthostatic hypertension n=11, chronotropic incompetence n=31, postural orthostatic tachycardia syndrome n=1). Patients with orthostatic hypotension showed significantly higher Unified Parkinson’s Disease Rating Scale-III values than those with chronotropic incompetence. The cross-sectional-area of the vagus nerve correlated inversely with heart rate in rest and supine position and positively with tilt test parameters representing parasympathetic modulation through vagal activity (high frequency power of the distance between two consecutive R waves in electrocardiogram (RR-Interval)) at rest. We demonstrate for the first time that morphological characteristics of the vagus nerve correlate with parameters of parasympathetic function from the spectral analysis of cardiovascular parameters in tilt test for Parkinson´s patients. This correlation reveals the impact of the atrophy of vagal atrophy for autonomic function in Parkinson´s disease. Nerve ultrasound of the vagus nerve could potentially be used as an adjunct to tilt table examination to diagnose autonomic dysfunction.

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“… 17 , 20 In the context of CIDP, an autonomic dysfunction has been described only in rare cases; therefore, a CSA increase of the vagus nerve compared to controls was not expected. 36 …”

Section: Discussionmentioning

confidence: 99%

Vagal cross-sectional area correlates with parasympathetic dysfunction in Parkinson's disease

Huckemann

Mueller

Averdunk

et al. 2022

Brain Communications

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“…Ki ta au to imu ni në li ga, su ku ria sie ja mas to ni nis vyz dys, yra sar koi do zë -ðiuo at ve ju magne ti nio re zo nan so to mog ra fi jos ty ri me ga li bû ti ste bi mas ryð kes nis, nei ápras tai, krum ply no maz gas [11]. Guil lain-Bar re sin dro mas ir Vogt-Ko y a na gi-Ha ra da li ga taip pat yra su si jae su to ni nio vyz dþio ið si vys ty mu, ta èiau ðios sà sa jos dar në ra vi sið kai ið tir tos [12,13].…”

Section: Etiologijaunclassified

“…To ni nis vyz dys taip pat sie ja mas su pa ra ne op las ti niais sin dro mais (Hodþ ki no lim fo ma, krû tø vë þiu, tar pup lau èio smul kiø jø làs te liø kar ci no ma, ade noi di ne cis ti ne kar ci noma), anes te zi ja, vais tø var to ji mu ir ki to mis bûk lë mis [7,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28].…”

Section: Etiologijaunclassified

“…Dau ge liui pa cien tø su Adie vyz dþiu gy dy mas ne rei ka lingas. Jei diag no zuo ja ma ani zo ko ri jà su kë lu si vie na ið sis temi niø au to no mi niø neu ro pa ti jø, gy do ma vy rau jan ti pa tolo gi ja [4,14,[10][11][12][13][14][15][16]. Esant ið reikð tai fo to fo bi jai, re ko menduo ja mi aki niai su fo toch ro mi niais fil trais, su tri kus akomo da ci jai -aki niai skai ty mui.…”

Section: Gydymasunclassified

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Adie pupil. Literature review

Judickaitė,

Zizas,

Varoniukaitė

et al. 2023

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Anisocoria (unequal pupil size) is a condition described as various lacerations in iris sphincter or dilator muscles, innervation abnormalities, or conditions caused by external pharmacological agents. Adie pupil is one of the causes of anisocoria. Adie pupil is a rare neurological disorder which represents itself with unilateral or bilateral mydriasis, unresponsiveness to bright or dim light, and constriction on accommodation. This condition is idiopathic, affecting 25-45-year-old adults, more frequently women. The symptoms are a unilateral or bilateral dilated pupil, photophobia, and blurred vision. The diagnosis is based on patients’ symptoms, clinical examination findings, and a dilute pilocarpine test can also be performed. Most patients do not need treatment. In this article, we review the epidemiology, pathogenesis, etiology, clinical evaluation, diagnostic features, treatment of Adie pupil, its relationship with COVID-19, and other conditions that cause anisocoria.

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“…Nesti et al [16] reported a complex multisystem phenotype associated with the mitochondrial DNA m.5522G > A mutation. Escorcio-Bezerra et al [17] focused the attention on tonic pupils as an unusual autonomic involvement in chronic inflammatory demyelinating polyneuropathy (CIDP), while Kobayashi et al [18]) suggested that ischemic stroke was associated to sarcoidosis for the presence of arterial wall enhancement. Qin [19] showed association of HIF1A and Parkinson's disease in a Han Chinese population by molecular inversion probe analysis, and Yin et al [20] by a meta-analysis reported the relationship with BDNF Val66Met polymorphism and cognitive impairment in Parkinson's disease.…”

Section: Clinical Aspects Of Rare Neurologic Diseasesmentioning

confidence: 99%

Rare Neurologic Diseases and Neurological Sciences: a report for the celebration of the 2020 Rare Diseases Day

Federico

2020

Neurol Sci

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Tonic pupils: an unusual autonomic involvement in chronic inflammatory demyelinating polyneuropathy (CIDP)

Cited by 6 publications

References 9 publications

Vagal cross-sectional area correlates with parasympathetic dysfunction in Parkinson's disease

Vagal cross-sectional area correlates with parasympathetic dysfunction in Parkinson's disease

Adie pupil. Literature review

Rare Neurologic Diseases and Neurological Sciences: a report for the celebration of the 2020 Rare Diseases Day

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