A 50-year-old male patient gives history of STD acquired 20 years back, now complaints of headache, seizures, confusion and numbness in extremities. Which of the following will be true about the pupillary response of the above patient?
**Core Concept**
The patient's symptoms suggest a possible neurosyphilis complication, specifically tabes dorsalis, which is a late manifestation of syphilis infection. This condition affects the posterior columns of the spinal cord and can lead to various neurological symptoms, including altered pupillary responses.
**Why the Correct Answer is Right**
In tabes dorsalis, the degeneration of the posterior columns of the spinal cord affects the dorsal root ganglia, leading to the disruption of the autonomic nervous system's control over the pupils. This results in an abnormal pupillary response, specifically the Argyll Robertson pupil. The Argyll Robertson pupil is characterized by bilateral small pupils that constrict in response to accommodation but do not react to light. This unique response is due to the disruption of the parasympathetic pathway, which is responsible for the constriction of the pupils in response to light.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because the Argyll Robertson pupil is a specific type of pupil abnormality that is not typically associated with other conditions such as glaucoma or Horner's syndrome.
**Option B:** This option is incorrect because the patient's symptoms do not suggest a condition that would cause anisocoria, which is the unequal size of the pupils.
**Option C:** This option is incorrect because the patient's symptoms do not suggest a condition that would cause an afferent pupillary defect, which is a defect in the afferent pathway of the pupillary light reflex.
**Clinical Pearl / High-Yield Fact**
The Argyll Robertson pupil is a classic sign of tabes dorsalis, a late complication of syphilis infection. This sign is often remembered as "pupils that constrict with accommodation but not with light, in a patient with a history of STD."
**Correct Answer:** C. The patient will have an Argyll Robertson pupil.