Oculosympathetic spasm with cervical spinal cord injury
L. B. Kline, S. M. McCluer and F. P. Bonikowski
A 23-year-old man, involved in a motor-vehicle accident, became
quadraparetic due to cervical spinal cord injury at the C-4 to C-6 level.
Five months later he was noted to have bilateral, asymmetric pupillary
mydriasis precipitated by elevation and stretch of an arm or leg.
Pharmacologic pupillary testing and ciliospinal reflex responses suggested
that the oculosympathetic pathways were intact. Computed tomographic
myelography using metrizamide disclosed a posttraumatic syringomyelic cyst
at C-4. This pupillary phenomenon has been termed oculosympathetic spasm,
and we reviewed four previous reports. While the cause of oculosympathetic
spasm remains speculative, it may represent a localized form of autonomic
hyperreflexia.
