American Board of Psychiatry and Neurology (ABPN) Practice Exam 2025 - Free ABPN Practice Questions and Study Guide

Argyll Robertson pupils are a classic clinical finding associated with tabes dorsalis, which is a late manifestation of syphilis caused by the bacterium Treponema pallidum. In this condition, the pupils are typically small, irregular, and react poorly to light while still accommodating for near vision. This finding reflects the involvement of the pupillary light reflex pathways in the midbrain, particularly affecting the Edinger-Westphal nucleus, which is responsible for constricting the pupil in response to light.

Tabes dorsalis occurs when the syphilis infection affects the central nervous system, leading to degeneration of the nerve pathways. The combination of absent pupillary light reflex and preserved accommodation directs practitioners towards a diagnosis of tabes dorsalis, making it a key identifier in history and examination.

While other conditions listed can have ocular manifestations, they are not characteristically linked to the phenomenon of Argyll Robertson pupils. For instance, multiple sclerosis may cause a range of visual disturbances but does not typically yield this distinctive pupil reaction. Lyme disease can cause various neurological symptoms, yet it does not classically present with this specific pupillary finding. Intracerebral aneurysms can lead to other ocular signs if they affect surrounding structures but not specifically Argy