1- pupillary disorders:
Argyll-Robertson syndrome (syphilis): small pupils, irregular, uneven, the pupillary light reflex is abolished (direct and consensual), while the accommodation-convergence is preserved.
* Adie Syndrome: unilateral pupillary areflexia tendon + anomalies. The affected pupil is moderately dilated, direct and consensual RPM is completely or almost completely abolished. Slow pupillary contraction and relaxation.
* Horner’s syndrome is due to a lesion of the sympathetic fibers and associates miosis, moderate ptosis and enophthalmos. The lesion may sit in the retro-olivary bulb region (Wallenberg syndrome) or may be peripheral (Pancoast’s syndrome). +/- Hemifacial anhidrosis.
2- genitourinary sphincter disorders:
A- voiding disorders:
* Peripheral lesions interrupting the reflex arc tend to produce a re-tention with progressive distension of hypotonic bladder; this chronic retention can be complicated overflow incontinence.
* Acute spinal cord injury can result in inhibition of func-tioning reflex. Later -> neurogenic bladder.
* Automatic Bladder: urination weak and brief or frank urination, inde-pendent, independent of the will, occurring in response to sensory stimuli o to a bladder pressure
The frontal lesions make possible a urination behavior by releasing hypothalamic mechanisms.
B- sexual disorders:
* Erection: under-the influence of parasympathetic fibers from the sacral cord (S2-S4).
* Ejaculation: is an integrated reflex at high lumbar cord (L1-L3) -> friendly.
* Hypersexuality: Klüver and Bucy syndrome (hippocampal lesion); Klein & Levin syndrome (hypothalamic disturbances).
* Klein-Levin syndrome: combines access hypersomnia, polyphagia, behavioral problems (aggression, high sex drive …) These episodes last one week, occurring 2-3 times a year, disappearing for no apparent reason. It is due to hypothalamic disturbances.
