Transient Benign Unilateral Pupillary Dilation in Young Adults

Abstract

Transient unilateral pupillary dilation occurred in four young adults who otherwise had normal clinical neurological examination results and normal cerebral arteriograms. The cause of this benign syndrome is unknown, but some cases may be variants of ophthalmoplegic migraine.(Arch Neurol 31: [12][13][14] 1974) Fur young adult patients with transient unilateral pupillary di¬ lation were evaluated at the New York Hospital during a six-month period. Except for the pupillary ab¬ normality, their neurological exami¬ nation results and cerebral artério¬ graphie studies were normal. Though cases of episodic unilateral pupillary dilation have been described previ¬ ously,1·2 no single cause explains the abnormality in all such cases, and the condition has not been emphasized in neurological reports. Report of CasesCase l.-A 26-year-old emotionally stable physician first noted left pupillary dilation in a setting of sleep deprivation for which he was taking caffeine tablets. The left pupil was observed by another physician to be 7 to 9 mm in diameter, and the right pupil 3 to 4 mm in diameter. Both pupils were round and reacted briskly to direct and consensual Tight _as well as to near gaze, constricting to diameters of 5 "and 2 mm, respectively. There was no other neurological abnormality. The left pupil returned to normal in four hours, but three days later another episode of dilation occurred, lasting several hours. Twoday_s_ after that, he developed a dull, left, retroorbital headache fjjllowed in two hours bv jeft pupillary dilation, and he was ad¬ mitted to the hospital. He denied using eye drops or having either a personal or family history of headache. At admission the left pupil was 7 mm and the right 5 mm in diameter. Both pupils were round and re¬ acted to direct and consensual light and to near gaze, constricting to 4 and 3 mm, re¬ spectively. There was no ptosis, and the ex¬ traocular movements were normal. Deep tendon reflexes were present, and findings from the remainder of his examination were normal. The mydriasis cleared in six Jiours.A left carotid arteriogram, including the posterior communicating artery, was nor¬ mal. Skull and chest x-ray films, brain scan, electroencephalogram, erythrocyte sedimentation rate (ESR), oral glucose tol¬ erance test, and serum VDRL test for syphilis were normal. Cerebrospinal fluid (CSF) was acellular with an opening pres¬ sure of 155 mm CSF; glucose level, 73 mg/100 ml; protein concentration, 15 mg/100 ml; and -globulin value, 4.8%.The patient had one additional six-hour, episode of mydriasis with preserved pupil¬ lary reactivity in the hospital and has had two since discharge^None was associated "with headache. His pupils did not react to ã 5!5% ophthalmic solution of methacholine three weeks after discharge.Case 2.-A 26-year-old woman noted left pupillary dilation associated with scratchy conjunctival irritation. A mild, diffuse headache followed, at which time she experienced blurred vision when reading. She_ denied previous headaches or a familyTustory of migraine...

Ophthalmoplegic migraine

“…Patients with transient mydriasis also have been reported, with a migraine pathophysiology hypothesized [22,23]. Whether these groups of patients should be considered to represent acephalgic ophthalmoplegic migraine is debatable.…”

Migraine with Benign Episodic Unilateral Mydriasis

“…3 The occurrence of mydriasis in ophthalmoplegic migraine can be due to functional exhaustion of parasympathetic fibers running within the IIIrd cranial nerve. 6 Other possible mechanisms include ischemia or oculomotor nerve demyelination caused by neuropeptides secreted at the level of circle of Willis upon the activation of the trigeminovascular system causing edema and inflammation. 7 According to one report of seven patients with BEUM associated with migraine, four had classic, one had common, and one had post-traumatic migraine.…”

Migraine with benign episodic unilateral mydriasis

“…However, some cases have been described with no accompanying headache 3. The occurrence of mydriasis in ophthalmoplegic migraine can be due to functional exhaustion of parasympathetic fibers running within the IIIrd cranial nerve 6. Other possible mechanisms include ischemia or oculomotor nerve demyelination caused by neuropeptides secreted at the level of circle of Willis upon the activation of the trigeminovascular system causing edema and inflammation 7…”