Neuropediatrics 2017; 48(03): 185-187
DOI: 10.1055/s-0036-1597614
Short Communication
Georg Thieme Verlag KG Stuttgart · New York

Is Tadpole Pupil in an Adolescent Girl Caused by Denervation Hypersensitivity?

Jonas Kjeldbjerg Hansen
1   Department of Pediatrics, Regional Hospital Viborg, Viborg, Denmark
,
Hans Ulrik Møller
2   Department of Pediatric Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
› Author Affiliations
Further Information

Publication History

22 August 2016

14 November 2016

Publication Date:
04 January 2017 (online)

Abstract

Tadpole pupil is a rarely encountered phenomenon caused by episodic, segmental iris dilator muscle spasm of short duration (2–15 minutes), occurring in clusters without a known precipitating factor. It has most commonly been described in women aged 28 to 48 years. A few hypotheses on pathogenesis have been discussed but none has been proved. Here, we present an adolescent girl with bilateral tadpole pupil that appeared during physical exercise. This is the first pediatric case of tadpole pupil, not caused by preceding surgery, to be published. Based on (1) this case in which tadpole pupil developed when the norepinephrine level rose during exercise, (2) the high ratio of patients with tadpole pupil who concurrently have or later develop Horner syndrome, in which denervation hypersensitivity is well described, (3) a previous report of a patient with both tadpole pupil and Horner syndrome who had denervation hypersensitivity on pharmacological testing, (4) a 29-year-old man with unilateral tadpole pupil induced by exercise, and (5) a 19-year-old man with bilateral tadpole pupil and possible autonomic neuropathy, we suggest denervation hypersensitivity as a probable pathogenic mechanism causing tadpole pupil. In addition, a suggestion for investigations to be performed in future pediatric cases is provided.

 
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