Is Tadpole Pupil in an Adolescent Girl Caused by Denervation Hypersensitivity?

Tadpole pupil is a rarely encountered phenomenon caused by episodic, segmental iris dilator muscle spasm of short duration (2–15 minutes), occurring in clusters without a known precipitating factor. It has most commonly been described in women aged 28 to 48 years. A few hypotheses on pathogenesis have been discussed but none has been proved. Here, we present an adolescent girl with bilateral tadpole pupil that appeared during physical exercise. This is the first pediatric case of tadpole pupil, not caused by preceding surgery, to be published. Based on (1) this case in which tadpole pupil developed when the norepinephrine level rose during exercise, (2) the high ratio of patients with tadpole pupil who concurrently have or later develop Horner syndrome, in which denervation hypersensitivity is well described, (3) a previous report of a patient with both tadpole pupil and Horner syndrome who had denervation hypersensitivity on pharmacological testing, (4) a 29-year-old man with unilateral tadpole pupil induced by exercise, and (5) a 19-year-old man with bilateral tadpole pupil and possible autonomic neuropathy, we suggest denervation hypersensitivity as a probable pathogenic mechanism causing tadpole pupil. In addition, a suggestion for investigations to be performed in future pediatric cases is provided.

Role of the Suprachiasmatic Nucleus in the Pathogenesis of Migraine Attacks

Neuroanatomic, morphometric, immunocytochemical, neurobiochemical and clinical data support the hypothesis that the suprachiasmatic nucleus of the hypothalamus might be the initial site of migraine attacks. The prodromal phase of a migraine attack could be considered a syndrome of functional suprachiasmatic nucleus insufficiency, and other phases a reactive denervation hypersensitivity with the affection of the visual, nociceptive, antinoacceptive and cranial vasomotor system.

Effect on muscarinic acetylcholine receptors after experimental neuronal ablation in rat colon

The etiology of denervation hypersensitivity was studied using a rat model. Degeneration of the myenteric plexus was produced by direct application of 0.1% benzalkonium chloride to the serosal surface of the distal colon. Thirty days later, the treated group was compared with a control group undergoing a sham operation. The treated group showed that the decreased number of ganglion cells of the myenteric plexus on routine stain and acetylcholinesterase staining demonstrated the myenteric plexus in the treated group diminished acetylcholinesterase activity. Methacholine (1%), a muscarinic agonist, increased intraluminal pressure in treated but not control rats. The dose-response curve of colonic muscle strips to oxotremorine showed a shift to the left, indicating greater sensitivity, in the treated bowel, with a 50% effective dose (ED50) of 2.5 x 10(-8) in treated muscle and 2.2 x 10(-7) in controls. Binding studies using [3H]quinuclidinyl benzilate ([3H]QNB) showed that the specific maximal binding (Bmax) for [3H]QNB was greater in treated than in untreated animals (228 +/- 26.1 and 135 +/- 42.9 fmol/mg protein, respectively; P < 0.01), even though the dissociation constants (Kd) were the same (0.398 +/- 0.083 and 0.406 +/- 0.065). These findings show that acquired denervation hypersensitivity in this model is due to an increase in the number of muscarinic acetylcholine receptors.