Anisocoria indicates an inequality in pupil size between the right and left pupils.
Light reflex = direct/indirect Horner's syndrome: see Horner's syndrome Ciliospinal reflex: see CN and Coma Pinpoint pupils:
May be a sign of opioid intoxication or a structural lesion of the pons (pontine hemorrhage).
Foodborne: Cranial nerve duction appears first, then dilated fixed pupils (not always present)
Argyll Robertson pupils
Optic nerve lesions: (swinging flashlight test) - MS Adie tonic pupils
Unilateral dilatation: Raised intracranial pressure
Chadwick D (1993) The cranial nerves and special senses. In: Walton J (ed) Brain's diseases References of the nervous system. Oxford University Press, Oxford, pp 76-126 Shintani RS, Tsuruoka S, Shiigai T (2000) Carotid cavernous fistula with brainstem congestion mimicking tumor on MRI. Neurology 55: 1229-1931
Multiple and combined oculomotor nerve palsies
Fig. 18. Orbital metastasis: A Atypical optomotor function; B Exophthalmos, best seen from above; C CT scan of orbital metastases
Site of lesion
Infarction Leigh syndrome Tumor
Aneurysm Clivus tumor
Thyroid eye disease
Associated brainstem signs
Other cranial nerve palsies
Ophthalmic division of trigeminal nerve involved, orbital swelling pain
Cranial arteritis Miller Fisher syndrome Diabetes Toxic
Differential diagnosis: orbital muscle disease including thyroid disease, MG, rare ocular myopathies
Garcia-Rivera CA, Zhou D, Allahyari P, et al (2001) Miller Fisher syndrome: MRI findings. Neurology 57: 1755-1769
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