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A 34-year-old woman reported that the right side of her face was warmer than the left and had an unusual propensity for sweating. (Panels A and B were obtained after she had been running.) Six years earlier, anisocoria of the left eye had developed that was diagnosed as tonic, or Adie's, pupil. On examination, she had a left-sided tonic pupil with light–near dissociation and a positive pilocarpine test. In addition, ankle jerks were absent and she had pathological autonomic functions, confirming the presence of Adie's syndrome. There were no other signs of sympathetic pupillary dysfunction or Horner's syndrome. A structural lesion was excluded with magnetic resonance imaging of the cranium and cervical spine, including the sympathetic ganglia. The occurrence of Adie's syndrome and segmental anhidrosis or hypohydrosis has been referred to as Ross syndrome and consists of cranial postganglionic parasympathetic and sympathetic dysfunction in association with more widespread autonomic failure that is rarely clinically relevant. The course is usually benign with a possible expansion of the dyshidrotic area.
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