'Inverse Argyll Robertson pupil' in botulism: Late central manifestation

'Inverse Argyll Robertson pupil' or inverse light-near dissociation is usually ascribed to central nervous system dysfunction. A patient with botulism developed pupils reactive to light but poorly to near stimuli six weeks following initial presentation with complete ophthalmoplegia. This suggests retrograde transport of botulinum toxin, and calls to reconsider the role of the Edinger-Westphal nucleus as a common preganglionic nucleus for pupillary neurons in the ciliary ganglion.