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161. Inequality of the direct and consensual light reflexes in normal subjects. (PubMed)

Inequality of the direct and consensual light reflexes in normal subjects. Anisocoria in darkness and during reflex responses to unilateral light stimulation was studied in 150 normal subjects with television pupillometry. It was commonly found that the direct light reaction of the stimulation eye exceeded the consensual reaction of the other eye. This light-induced anisocoria, termed 'contraction anisocoria', had a mean value of 0.075 mm or 6.1 % of light reflex amplitude. The measurement (...) showed a high degree of repeatability in 20 subjects who were tested on two occasions a year apart. It occurred in the presence and absence of prior dark adaptation and increased proportionally with reflex amplitude as the intensity of the stimulating light was raised. IT IS CONCLUDED THAT, CONTRARY TO PREVIOUS OPINION, A SMALL DEGREE OF CONTRACTION ANISOCORIA IS NORMAL.

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1979 The British journal of ophthalmology

162. Overview of Neuro-ophthalmologic and Cranial Nerve Disorders

light. If an efferent defect is present, the pupil responds sluggishly or does not respond to both direct and consensual light. Table Common Pupillary Abnormalities Finding Explanation Asymmetry of 1–2 mm between pupils, preserved light responses, and no symptoms Normal variant (physiologic anisocoria) Asymmetry, impaired light responses, and preserved response to accommodation (light-near dissociation or Argyll Robertson pupil) Neurosyphilis (possibly) Bilateral constriction Opioids Miotic eye

2013 Merck Manual (19th Edition)

163. Horner Syndrome

degenerated; the result is increased anisocoria. If the lesion is below the superior cervical ganglion (preganglionic or central Horner syndrome) and the postganglionic fibers are intact, the pupil of the affected eye also dilates, and anisocoria decreases. Apraclonidine : Apraclonidine is a weak alpha-adrenergic agonist that minimally dilates the pupil of a normal eye. If a postganglionic lesion is present (peripheral Horner syndrome), the pupil of the affected eye dilates much more than (...) that of the unaffected eye because the iris dilator muscle of the affected eye has lost its sympathetic innervation and has developed adrenergic supersensitivity. As a result, anisocoria decreases. (However, results may be falsely normal if the causative lesion is acute.) If the lesion is preganglionic (or a central Horner syndrome), the pupil of the affected eye does not dilate because the iris dilator muscle does not develop adrenergic supersensitivity; as a result, anisocoria increases. If results suggest Horner

2013 Merck Manual (19th Edition)

164. Cavernous Sinus Thrombosis

with cavernous sinus thrombosis may also have anisocoria or mydriasis (3rd cranial nerve dysfunction), papilledema, and vision loss. Diagnosis MRI or CT Cavernous sinus thrombosis is often misdiagnosed because it is rare. It should be considered in patients who have signs consistent with . Features that distinguish cavernous sinus thrombosis from orbital cellulitis include cranial nerve dysfunction, bilateral eye involvement, and mental status changes. Diagnosis is based on neuroimaging. MRI is the better

2013 Merck Manual (19th Edition)

165. Ciliary ganglion

in roughly 1 out of every 500 people. A patient with anisocoria (one pupil bigger than the other) whose pupil does not react to light (does not constrict when exposed to bright light) most likely has Adie syndrome – idiopathic degeneration of the ciliary ganglion. Physiology [ ] The strange behavior of tonic pupils was first explained by Irene Loewenfeld in 1979. The ciliary ganglion contain many more nerve fibers directed to the ciliary muscle than nerve fibers directed to the constrictor pupillae

2012 Wikipedia

166. Spontaneous Intracranial Epidural Hematoma Originating from Dural Metastasis of Hepatocellular Carcinoma (PubMed)

Spontaneous Intracranial Epidural Hematoma Originating from Dural Metastasis of Hepatocellular Carcinoma Spontaneous intracranial epidural hematoma (EDH) due to dural metastasis of hepatocellular carcinoma is very rare. A 53-year-old male patient with hepatocellular carcinoma, who was admitted to the department of oncology, was referred to department of neurosurgery because of sudden mental deterioration to semicoma with papillary anisocoria and decerebrate rigidity after transarterial

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2010 Journal of Korean Neurosurgical Society

167. February cover (PubMed)

February cover 20393087 2012 03 26 2013 11 21 1715-5258 56 4 2010 Apr Canadian family physician Medecin de famille canadien Can Fam Physician February cover. 329; author reply 330 Dickson Robert C RC eng Letter Canada Can Fam Physician 0120300 0008-350X 0 Bronchodilator Agents QF8SVZ843E Albuterol IM Albuterol administration & dosage Anisocoria pathology Bronchodilator Agents administration & dosage Child Humans Male Metered Dose Inhalers Strabismus 2010 4 16 6 0 2010 4 16 6 0 2012 3 27 6 0

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2010 Canadian Family Physician

168. The sequential trauma score - a new instrument for the sequential mortality prediction in major trauma* (PubMed)

that age was a significant predictor of survival (AUC(model P), area under the curve = 0.63). Logistic regression of the prehospital data (A) showed that blood pressure, pulse rate, Glasgow coma scale (GCS), and anisocoria were significant predictors (AUC(model A) = 0.76; AU(model P + A) = 0.82). Logistic regression of the early trauma room phase (B1) showed that peripheral oxygen saturation, GCS, anisocoria, base excess, and thromboplastin time to be significant predictors of survival (AUC(model B1

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2010 European Journal Of Medical Research

169. Mortality in severe traumatic brain injury: a multivariated analysis of 748 Brazilian patients from Florianópolis City. (PubMed)

= 5.56-23.87, p < 0.0001), or anisocoria (OR = 2.65, 95% CI = 1.69-4.17, p < 0.0001) in comparison to isocoric pupils. There was a trend for higher mortality in patients with type III injury on the Marshall classification of CT (OR = 3.63, 95% CI = 0.84-15.76, p = 0.08) than in patients with normal CT. Patients without thoracic trauma disclose higher mortality than patients with associated thoracic trauma do (OR = 2.02, 95% CI = 1.19-3.41, p = 0.009). The final model presented disclosed 76.9

2009 Journal of Trauma

170. A 14-year follow-up of photorefractive keratectomy. (PubMed)

logMAR -0.11 +/- 0.55, and BSCVA logMAR -0.03 +/- 1.00. At 14 years, BSCVA for most eyes was at least equal to preoperative BSCVA. In both groups, haze increased between 3 and 6 months, then declined in the first year. A temporary increase of IOP was seen in 4 eyes. Complications were minor haze (2 eyes), transient anisocoria (9 eyes), and intraepithelial hemosiderin deposits (4 eyes). No abnormalities in endothelial cell count or morphology, astigmatism, or ectasia were noted. Three patients

2009 Journal of Refractive Surgery

171. Unilateral mydriasis Due to hemorrhoidal ointment. (PubMed)

Unilateral mydriasis Due to hemorrhoidal ointment. The finding of a unilaterally dilatated pupil in a patient who is otherwise alert and unimpaired can pose an interesting diagnostic problem. Algorithms have outlined the approach to evaluating anisocoria, but do not stress the importance of toxic exposures.A patient with a history of depression and chronic headaches was referred to the emergency department from an ophthalmologist's clinic with the findings of asymmetrically dilatated pupils

2009 Journal of Emergency Medicine

172. Monitoring intracranial pressure in patients with malignant middle cerebral artery infarction: is it useful? (PubMed)

on the first CT scan and underwent surgery without prior ICP monitoring. This study focuses on the subgroup of 19 patients who underwent intraparenchymatous ICP monitoring before surgery.Intracranial pressure readings were evaluated and correlated with pupillary abnormalities, MLS, and ischemic tissue volume. In 12 of the 19 patients, ICP values were always < or = 20 mm Hg, despite a mean (+/- SD) MLS of 6.7 +/- 2 mm and a mean ischemic tissue volume of 241.3 +/- 83 cm(3). In 2 patients with anisocoria

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2009 Journal of Neurosurgery

173. Emergency Department Skull Trephination for Epidural Hematoma in Patients Who Are Awake But Deteriorate Rapidly. (PubMed)

in the age of computed tomography (CT) scanning.Patients with EDH from blunt trauma, either in our institution or known to our graduate network, who were T&D with anisocoria despite intubation plus medical therapy, and who had pre-transfer EP trephination, were compared to those who were transferred without trephination.There were 5 patients with blunt trauma and CT-proven EDH who were T&D with anisocoria who underwent Emergency Department (ED) trephination at outlying hospitals before transfer. All 5 (...) had improvement in condition and good outcomes. Three had complete recovery without disability and 2 others had mild disability with good cognitive function. None had complications. Two patients with T&D and anisocoria were transferred without trephination. Both had good neurologic outcomes. The mean time to pressure relief in the trephination group vs. transfer group was 55 vs. 207 min, respectively.In T&D patients with CT-proven EDH and anisocoria, ED skull trephination before transfer resulted

2009 Journal of Emergency Medicine

174. The Trauma- Formula-Driven Versus Lab-Guided Study (TRFL Study)

(defined as any of the following: Glasgow Coma Scale of 3 due to severe traumatic brain injury; clear indication of immediate neurosurgical intervention based on clinical findings, mechanism of trauma associated with focal signs (anisocoria, CT evidence of intracranial bleeding with mass effect); or iv) they had evidence of having a catastrophic head injury (such as transcranial gunshot wound, open skull fracture with exposure/loss of brain tissue, or expert opinion by either the trauma team leader

2009 Clinical Trials

175. Duration and predictors of emergency surgical operations - basis for medical management of mass casualty incidents (PubMed)

) and anisocoria (OR 1,28) on-scene.The mean operation time of 130min calculated for emergency life-saving surgical operations provides a realistic guideline for the prospective treatment capacity which can be estimated and projected into an actual incident admission capacity. Knowledge of predictive factors for life-saving emergency operations helps to identify those patients that need most urgent operative treatment in case of blunt MCI.

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2009 European Journal Of Medical Research

176. Regression of Urrets-Zavalia Syndrome After Deep Lamellar Keratoplasty for Keratoconus: A Case Study (PubMed)

Regression of Urrets-Zavalia Syndrome After Deep Lamellar Keratoplasty for Keratoconus: A Case Study We report a case of pharmacologic regression of Urrets-Zavalia syndrome, following deep lamellar keratoplasty for severe keratoconus. Sympatholytic and parasympathomimetic drops were administered and a progressive reduction of mydriasis and restoring of pupillary kinetics were observed. Four years after surgery, it was resulting in only slight residual anisocoria.

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2008 The open ophthalmology journal

177. Combined Cardiac–Neurosurgical Treatment of Acute Aortic Dissection, Stroke, and Coma (PubMed)

family approved an emergency Bentall operation. She regained consciousness but developed anisocoria and Glasgow Coma Scale level-4 coma 30 hours after the operation. Computed tomography showed massive cerebral infarction with hernia of the uncus gyri hippocampi. Emergency surgical cerebral decompression was performed. The patient survived; after 1 year, she had full mental acuity and minor left motor sequelae.

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2008 Texas Heart Institute Journal

178. Head CT in patient with metabolic acidosis (PubMed)

sessions of hemodialysis, the patient remained unresponsive despite minimal sedation. Anisocoria was noted on exam. Computed tomography of the brain demonstrated a large hematoma in the left basal ganglia that extended into the left frontal and parietal white matter accompanied by intraventricular extension, midline shift, loss of grey-white differentiation throughout, suggesting tonsillar herniation (Figure 1). Forty-eight hours after presentation, radionuclide imaging of the brain revealed

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2008 Journal of Medical Toxicology

179. Gender-specific lateralization of contraction anisocoria in transient pupillary light reflex. (PubMed)

Gender-specific lateralization of contraction anisocoria in transient pupillary light reflex. Contraction anisocoria describes a phenomenon in which the pupil of a directly illuminated eye constricts more than the pupil of the consensual (not illuminated) eye. The purpose of this study was to investigate the lateralization of contraction anisocoria in young female and male subjects.Infrared binocular pupillography was used to measure pupillary light reflex (PLR) in 44 healthy children (23 girls (...) , 21 boys) from 6 to 16 years of age. Measurements were conducted in both light-adapted and dark-adapted conditions with different stimulus intensities. Relative constriction amplitude was obtained by dividing the maximal pupil area change by the initial static pupil area. Contraction anisocoria was calculated by subtracting relative constriction amplitude in the consensual eye from that of the direct eye. Values of contraction anisocoria obtained by stimulating a subject's right or left eye were

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2008 Investigative Ophthalmology & Visual Science

180. Pupillary Abnormalities

flashlight test, whereas the normal eye will both constrict normally and show a normal consensual response. It can be hard to perform the test accurately. Examiner bias, light position variability, and difficulty observing both eyes, dark irises, pre-existing anisocoria, small pupils and the presence of efferent defects may make it difficult to detect asymmetry. In glaucoma an RAPD indicates that there is more optic nerve damage in one eye than in the other, even if the visual acuity in both eyes (...) ) to their near point (about an arm's length away) and observe the pupillary reflex when their fixation shifts to the near target. A normal test shows a brisk constriction. In near-light dissociation, the patient has a better pupillary near reflex than light reflex. Pupillary abnormalities [ ] Pupillary disorders may involve the afferent pathways (RAPD) or the efferent pathways. Anisocoria, where not physiological, indicates a problem of the efferent pupillary pathway, either parasympathetic or sympathetic

2008 Mentor

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