THE PUPILLARY REACTIONS IN COMBINED LESIONS OF THE POSTERIOR COMMISSURE AND OF THE PUPILLODILATOR TRACTS

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Abstract
Attempts to localize the anatomic lesion in cases of the Argyll Robertson pupil were recently concentrated on the posterior commissure, a system of fibers that cross the midline dorsal to the sylvian aqueduct in the most cranial part of the mesencephalon. Particularly the anatomic studies of Lenz1and Papez and Freeman2and the experiments of Sachs3and of Ranson and Magoun4show that afferent fibers of the pupilloconstrictor light reflex arc enter the posterior commissure and have here at least a partial decussation. Thus the theory of Behr5seemed very promising ; this author explains the double-sided Argyll Robertson pupil by a lesion of the pupillomotor fibers at the place of decussation in the midbrain and the unilateral Argyll Robertson pupil by a lesion between the decussation in the midbrain and the sphincter nucleus, although Karplus and Kreidl6had elicited pupillary contraction

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