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Archives of Disease in Childhood.... Apr 2022Case presentationA 10-month-old boy was admitted to the emergency department due to a sudden onset of left unilateral mydriasis (figure 1). His medical history was...
Case presentationA 10-month-old boy was admitted to the emergency department due to a sudden onset of left unilateral mydriasis (figure 1). His medical history was unremarkable. A minor head trauma 2 days before was reported, without alarming signs or symptoms. His mother was putting him to sleep, after coming back from work, when she noticed a different pupil size and promptly went to the ED with her husband. The parents denied any use of medications, including nebulised therapy or direct contact with plants. The child was well appearing and his vital signs were within the standard age limits. His extraocular motility was normal as well as the rest of his neurological and physical examination. Parents' behaviour was somehow remarkable. Even though the child was not suffering, the mother seemed very worried while the father was nervous and aggressive, repeatedly asking for a discharge.
Topics: Anisocoria; Brain; Child; Female; Humans; Infant; Male; Mothers; Mydriasis; Sleep
PubMed: 33023918
DOI: 10.1136/archdischild-2020-319993 -
American Family Physician Feb 2019
Topics: Aged; Anisocoria; Diagnosis, Differential; Female; Horner Syndrome; Humans
PubMed: 30702257
DOI: No ID Found -
The Israel Medical Association Journal... Jan 2017The identification and prompt diagnosis of Horner syndrome (HS) is essential for preventing permanent damage. HS may arise when a lesion presents anywhere along the... (Review)
Review
The identification and prompt diagnosis of Horner syndrome (HS) is essential for preventing permanent damage. HS may arise when a lesion presents anywhere along the three-neuron oculosympathetic pathway that begins at the posterior-lateral nuclei of the hypothalamus all the way through to the orbit. We present four cases and review the literature to familiarize the reader with the identification, diagnosis and treatment of Horner syndrome. The four patients, three adults and one child, were followed for at least 6 months following the initial diagnosis (range 6-18 months). There was partial resolution in three of the four cases, while the fourth resolved completely. There are numerous causes of HS, some of them iatrogenic. While iatrogenic cases of HR are rare in both adults and children, HS is seen more often following surgical procedures. Prompt recognition of the syndrome and correction of the offending agent may prevent permanent damage to the neuronal pathway. It is therefore recommended that practitioners be aware of the risks for development of iatrogenic HS and the signs for early detection.
Topics: Adult; Aged; Anisocoria; Blepharoptosis; Female; Horner Syndrome; Humans; Iatrogenic Disease; Infant; Male; Young Adult
PubMed: 28457112
DOI: No ID Found -
Medicina Intensiva May 2017
Review
Topics: Adult; Anisocoria; Coma; Connective Tissue Diseases; Emergencies; Female; Heart Arrest; Humans; Hydroxychloroquine; Hypokalemia; Pregnancy; Pregnancy Complications; Suicide, Attempted
PubMed: 27480672
DOI: 10.1016/j.medin.2016.05.004 -
Binocular head-mounted chromatic pupillometry can detect structural and functional loss in glaucoma.Frontiers in Neuroscience 2023The aim of this study is to evaluate the utility of binocular chromatic pupillometry in detecting impaired pupillary light response (PLR) in patients with primary...
AIM
The aim of this study is to evaluate the utility of binocular chromatic pupillometry in detecting impaired pupillary light response (PLR) in patients with primary open-angle glaucoma (POAG) and to assess the feasibility of using binocular chromatic pupillometer in opportunistic POAG diagnosis in community-based or telemedicine-based services.
METHODS
In this prospective, cross-sectional study, 74 patients with POAG and 23 healthy controls were enrolled. All participants underwent comprehensive ophthalmologic examinations including optical coherence tomography (OCT) and standard automated perimetry (SAP). The PLR tests included sequential tests of full-field chromatic stimuli weighted by rods, intrinsically photosensitive retinal ganglion cells (ipRGCs), and cones (Experiment 1), as well as alternating chromatic light flash-induced relative afferent pupillary defect (RAPD) test (Experiment 2). In Experiment 1, the constricting amplitude, velocity, and time to maximum constriction/dilation were calculated in three cell type-weighted responses, and the post-illumination response of ipRGC-weighted response was evaluated. In Experiment 2, infrared pupillary asymmetry (IPA) amplitude and anisocoria duration induced by intermittent blue or red light flashes were calculated.
RESULTS
In Experiment 1, the PLR of POAG patients was significantly reduced in all conditions, reflecting the defect in photoreception through rods, cones, and ipRGCs. The variable with the highest area under the receiver operating characteristic curve (AUC) was time to max dilation under ipRGC-weighted stimulus, followed by the constriction amplitude under cone-weighted stimulus and the constriction amplitude response to ipRGC-weighted stimuli. The impaired PLR features were associated with greater visual field loss, thinner retinal nerve fiber layer (RNFL) thickness, and cupping of the optic disk. In Experiment 2, IPA and anisocoria duration induced by intermittent blue or red light flashes were significantly greater in participants with POAG than in controls. IPA and anisocoria duration had good diagnostic value, correlating with the inter-eye asymmetry of visual field loss.
CONCLUSION
We demonstrate that binocular chromatic pupillometry could potentially serve as an objective clinical tool for opportunistic glaucoma diagnosis in community-based or telemedicine-based services. Binocular chromatic pupillometry allows an accurate, objective, and rapid assessment of retinal structural impairment and functional loss in glaucomatous eyes of different severity levels.
PubMed: 37456990
DOI: 10.3389/fnins.2023.1187619 -
The Journal of International Medical... May 2022Strategies for the assessment of abnormal neurological findings during general anesthesia are limited. However, pupil abnormalities may represent serious neurological...
Strategies for the assessment of abnormal neurological findings during general anesthesia are limited. However, pupil abnormalities may represent serious neurological complications. We herein present a case of new-onset anisocoria and mydriasis that developed after scalp nerve block. The patient's signs were possibly related to increased intracranial pressure with resulting brain shift that ultimately affected the oculomotor nerves. A 45-year-old man was scheduled for left cerebellar tumor resection and ventricular drainage surgery; however, anisocoria and left pupillary mydriasis were observed after induction of general anesthesia and performance of scalp nerve block. After reducing the intracranial pressure, the right pupil showed constriction (1 mm) but the left pupil was dilated (5 mm). The pupils were of similar size postoperatively. Although pupillary dilation during general anesthesia has been previously described, this is the first case in which the mydriasis was considered to have been caused by brain shift due to increased intracranial pressure after scalp nerve block. Thus, we propose this phenomenon as a new possible cause of pupillary changes. Actively monitoring this presentation intraoperatively could enable early detection of and intervention for complications, therefore improving the prognosis.
Topics: Anisocoria; Humans; Intracranial Hypertension; Male; Middle Aged; Mydriasis; Nerve Block; Pupil; Scalp
PubMed: 35632980
DOI: 10.1177/03000605221099262 -
Iranian Journal of Allergy, Asthma, and... Feb 2021Pharmacological anisocoria is a rare but benign condition. This paper presents an eleven-year-old patient with asthma who developed ipratropium bromide-associated...
Pharmacological anisocoria is a rare but benign condition. This paper presents an eleven-year-old patient with asthma who developed ipratropium bromide-associated anisocoria during nebulizer treatment. Hypotheses regarding the possible causes of anisocoria are discussed and precautions to be taken during treatment are presented. To prevent the development of anisocoria, it was found that it is important to use the appropriate mask during nebulizer treatment, to place the mask on the face properly, and, if possible, to administer drugs by closing the eyes. Further, it is recommended that patients undergo an ophthalmological examination before discharge and that they and their families be informed that the condition is temporary.
Topics: Anisocoria; Child; Disease Management; Disease Susceptibility; Emergency Medical Services; Humans; Ipratropium; Nebulizers and Vaporizers; Symptom Assessment
PubMed: 33639629
DOI: 10.18502/ijaai.v20i1.5420 -
BMJ Case Reports Jul 2021The effects of COVID-19 on the eye are still widely unknown. We describe a case of a patient who was intubated and proned in the intensive care unit (ICU) for COVID-19...
The effects of COVID-19 on the eye are still widely unknown. We describe a case of a patient who was intubated and proned in the intensive care unit (ICU) for COVID-19 and developed unilateral anisocoria. CT venogram excluded a cavernous sinus thrombosis. MRI of the head showed microhaemorrhages in the midbrain where the pupil reflex nuclei are located. After the patient was stepped down from ICU, intraocular pressure (IOP) was found to be raised in that eye. A diagnosis of subacute closed angle glaucoma was made. It is important for clinicians to rule out thrombotic causes in patients who develop acute anisocoria. It is also crucial to measure IOP in patients who develop ophthalmic pathology and have been proned for extended periods.
Topics: Anisocoria; COVID-19; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Pupil; SARS-CoV-2
PubMed: 34301697
DOI: 10.1136/bcr-2020-240003 -
Turkish Journal of Anaesthesiology and... Jun 2023
PubMed: 37455544
DOI: 10.4274/TJAR.2022.221013 -
Turkish Journal of Anaesthesiology and... Jun 2015Post-traumatic carotid artery dissection is one of the major causes of ischemic stroke in young patients; its diagnosis remains a challenge for clinicians because of its...
Post-traumatic carotid artery dissection is one of the major causes of ischemic stroke in young patients; its diagnosis remains a challenge for clinicians because of its variable clinical presentation. An otherwise healthy 37-year-old man was referred to the intensive care unit of our faculty for the management of multiple trauma because of a car accident. At 11 days from admission, his doctor noticed the advent of anisocoria. A prompt treatment was instituted with anti-platelet and-coagulant agents. The patient had a complete resolution of symptoms. The prognosis was good, and the patient achieved a complete clinical recovery. He was discharged without any sequelae.
PubMed: 27366498
DOI: 10.5152/TJAR.2015.79847