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Show ! oumal of Cil/ lical Neur"-" phtha/ m" I< J~' Y 913 I: 171, J91.19, Editorial Comment Rhythmic Pupillary Oscillations '\) 1989 Raven Press, Ltd" New York The article, " Rhythmic Pupillary Oscillations Accompanying a Complete Third- Nerve Palsy," published in this issue of The ! ollnlal, was reviewed by a member of the editorial board, and favorably so, it should be added, To say that the reviewer in question might be called " Joe Pupil" would be an understatement, at best. His comments were sufficiently poignant that it seems reasonable to quote them here, ", , , I heard this paper , , , and on seeing it in print , , ' I am as mystified as ever. There was, it seems, a complete third- nerve palsy, yet the iris sphincter seemed to be getting parasympathetic innervation, One horn of this dilemma must crumble, Maybe it is not parasympathetic innervation? It seems unlikely that something local like substance P could be causing these strong, brief constrictions week after week. Maybe the damage to the third nerve was incomplete and actually spared the efferent pupil fibers ( fascicular? interpeduncular?), and a supranuclear lesion ( just proxi- 171 mal to the third- nerve nucleus) blocked the light reaction impulses to the right Edinger- Westphal nucleus only, You see the kind of wild speculation induced by a case like this. I think it is worth printing as a curiosity that may stimulate someone to look more carefully at pupils in coma, but I don't pretend to understand it. I have no similar cases, and I have nothing to say on the subject worth printing. " The only point one could reasonably disagree with in the paragraph above would be that the comments were not worth printing. I think it is a good thing to maintain honest intellectual humility, and therefore we are presenting both Dr. Keane's interesting observations and the reviewer's thoughts, and look forward to comments about any similar observations that you, dear reader, may have made! J. Lawton Smith, M. D. |