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Female With Asymmetrically Dilated Right Pupil
IMAGES IN EMERGENCY MEDICINE John Chin, MD 0196-0644/$-see front matter Copyright © 2014 by the American College of Emergency Physicians. http://dx.doi.org/10.1016/j.annemergmed.2014.04.016
Figure. Visual examination revealing an asymmetrically dilated and nonreactive right pupil. [figure used with permission]
[Ann Emerg Med. 2014;64:684.] A 24-year-old woman 3 days status post–L5-S1 fusion was transferred to the emergency department for observation after experiencing mild respiratory distress while undergoing computed tomography (CT) angiogram after a hospital stroke alert had been called to evaluate an asymmetrically dilated 8-mm nonreactive right pupil (Figure). A primary survey revealed a well-appearing patient in no acute distress. Aside from a bifrontal moderate headache, she felt well. The patient’s neurologic examination was otherwise normal, and a National Institutes of Health Stroke Scale score was 0. CT with angiogram and magnetic resonance imagining (MRI) results of the brain were negative for stroke and aneurysm. Review of her inpatient medication record indicated that a scopolamine patch was applied behind her right ear before surgery and had been removed several hours before her presenting symptom onset. The patient’s mydriasis and pupillary reactivity spontaneously improved during the next 2 days, and she was subsequently discharged home in stable condition.
For the diagnosis and teaching points, see page 689. To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com 684 Annals of Emergency Medicine
Volume 64, no. 6 : December 2014
Volume 64, no. 6 : December 2014
Annals of Emergency Medicine 689
Figure. Visual examination revealing an asymmetrically dilated and nonreactive right pupil. [figure used with permission]
[Ann Emerg Med. 2014;64:684.] A 24-year-old woman 3 days status post–L5-S1 fusion was transferred to the emergency department for observation after experiencing mild respiratory distress while undergoing computed tomography (CT) angiogram after a hospital stroke alert had been called to evaluate an asymmetrically dilated 8-mm nonreactive right pupil (Figure). A primary survey revealed a well-appearing patient in no acute distress. Aside from a bifrontal moderate headache, she felt well. The patient’s neurologic examination was otherwise normal, and a National Institutes of Health Stroke Scale score was 0. CT with angiogram and magnetic resonance imagining (MRI) results of the brain were negative for stroke and aneurysm. Review of her inpatient medication record indicated that a scopolamine patch was applied behind her right ear before surgery and had been removed several hours before her presenting symptom onset. The patient’s mydriasis and pupillary reactivity spontaneously improved during the next 2 days, and she was subsequently discharged home in stable condition.
For the diagnosis and teaching points, see page 689. To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com 684 Annals of Emergency Medicine
Volume 64, no. 6 : December 2014
Volume 64, no. 6 : December 2014
Annals of Emergency Medicine 689