The syndrome of alternating spastic and paretic phases of a periodic (cyclic) nature in paralysis of the third cranial (oculomotor) nerve has frequently been observed since it was first described by Rampoldi, in 1884. In 1942 Lowenstein and Givner,1 on the basis of pupillographic studies, showed that there is no real paralysis of the sphincter muscle and suggested therefore that the syndrome be spoken of no longer as a cyclic oculomotor paralysis but as an intermittent spasm of the third nerve with irregular periodicity (periodic spasmus mobilis oculomotorii). They showed that it is the result of partial destruction of the nucleus for the sphincter of the iris combined with supranuclear lesions, involving particularly the connections between the nucleus for the sphincter and the hypothalamus.
In contrast to this, periodic spasm of the sympathetic pupillary innervation has, to our knowledge, never been reported. In 1907 Westphal2 described the phenomenon