Reversible Mydriasis of Sudden Onset: Think Before You Act

The presence of abrupt anisocoria in clinical examination usually leads to the performance of urgent neuroimaging studies to exclude intracranial hemorrhage, although unilateral mydriasis might be the result of other benign etiologies. In this work, we report an illustrative case of a patient presen...

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Bibliographic Details
Published inThe Journal of emergency medicine Vol. 61; no. 4; pp. e77 - e79
Main Authors Garcia Castro, Jesús, Díaz de Terán, Javier
Format Journal Article
LanguageEnglish
Published Elsevier Inc 01.10.2021
Subjects
Anisocoria
Case report
Emergency
Intracranial hemorrhage
Ipratropium bromide
Mydriasis
Anisocoria
Intracranial hemorrhage
Case report
Mydriasis
Ipratropium bromide
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ISSN0736-4679
2352-5029
DOI10.1016/j.jemermed.2021.05.012

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Summary:The presence of abrupt anisocoria in clinical examination usually leads to the performance of urgent neuroimaging studies to exclude intracranial hemorrhage, although unilateral mydriasis might be the result of other benign etiologies. In this work, we report an illustrative case of a patient presenting with sudden-onset anisocoria while receiving ipratropium bromide nebulization in the emergency department to treat acute asthma. No other abnormalities were found on neurological examination and the computed tomography scan was normal. As a muscarinic antagonist, ipratropium bromide can produce mydriasis if accidentally instilled on one eye, thus leading to the suspicion of pharmacologic mydriasis. The pupils became isocoric after the discontinuation of the drug. A careful neurological examination and the history of treatment with mydriatic drugs might avoid unnecessary tests and radiation exposure.
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ISSN:0736-4679
2352-5029
DOI:10.1016/j.jemermed.2021.05.012