Ponsford J R, Bannister R, Paul E A
Brain. 1982 Sep;105 (Pt 3):583-97. doi: 10.1093/brain/105.3.583.
In order to examine the clinical usefulness of methacholine in assessing the site of ocular parasympathetic lesions, pupillary responses in man were measured in postganglionic (Adie's syndrome) and preganglionic third nerve lesions involving the pupil and in controls. From previous work with methacholine it might have been expected that greater constriction would occur in the postganglionic lesions but similar responses were found in both. Corneal hypoxia due to ptosis appeared unlikely to affect corneal permeability significantly and it is probable that these results reflect an increase responsiveness of the iris at, or distal to, the site of muscarinic acetylcholine receptors. Pupils contralateral to third nerve palsy, when tested on a separate occasion, also constricted by an amount approximately proportional to that of the clinically abnormal pupil. The possibilities that this may result in some way from reduction in total retinal illumination, or from retrograde changes in preganglionic pupilloconstrictor neurons affecting contralateral pupilloconstrictor neurons via central pathways, are discussed. It is concluded that supersensitivity to methacholine, tested carefully in the manner described, is a useful guide to the presence of parasympathetic denervation or decentralization, but that it is not reliable in distinguishing between the two sites.
为了研究乙酰甲胆碱在评估眼部副交感神经病变部位方面的临床实用性，我们对涉及瞳孔的节后（艾迪综合征）和节前动眼神经病变患者以及对照组的瞳孔反应进行了测量。根据之前对乙酰甲胆碱的研究，可能会预期节后病变会出现更大程度的收缩，但在两者中发现了相似的反应。由于上睑下垂导致的角膜缺氧似乎不太可能显著影响角膜通透性，这些结果可能反映了在毒蕈碱型乙酰胆碱受体部位或其远端虹膜反应性的增加。在单独的情况下测试时，与动眼神经麻痹对侧的瞳孔也会收缩，收缩程度与临床异常瞳孔大致成比例。讨论了这可能以某种方式由总视网膜光照减少导致，或者由节前瞳孔收缩神经元的逆行变化通过中枢途径影响对侧瞳孔收缩神经元引起的可能性。得出的结论是，按照所述方式仔细测试对乙酰甲胆碱的超敏反应，是副交感神经去神经支配或神经分散存在的有用指标，但在区分这两个部位方面并不可靠。
