Chaudhry Priyanka, Friedman Deborah I, Yu Wengui
Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.
Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A ; Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.
Indian J Crit Care Med. 2014 Mar;18(3):176-7. doi: 10.4103/0972-5229.128710.
Although there are many causes of anisocoria in the intensive care setting, the development of unilateral mydriasis in patients with intracranial hemorrhage or tumor is a neurological emergency, as it may herald the onset of uncal herniation. We describe two patients with a hemiparesis from neurosurgical disorder who subsequently developed a fixed and dilated pupil. The pupillary abnormality was caused by nebulized ipratropium bromide in both cases, and resolved when the medication was discontinued. Nebulized ipratropium may leak from the mask into ipsilateral eye and cause mydriasis in patients with facial weakness. This benign cause of anisocoria in the intensive care setting is distinguished from uncal herniation by the laterality of neurologic findings, and lack of mental status change, ptosis, and extraocular movement impairment.
尽管在重症监护环境中导致瞳孔不等大的原因众多，但颅内出血或肿瘤患者出现单侧瞳孔散大是一种神经急症，因为这可能预示着钩回疝的发生。我们描述了两名因神经外科疾病导致偏瘫的患者，他们随后出现了固定性瞳孔散大。在这两个病例中，瞳孔异常均由雾化吸入异丙托溴铵引起，停药后瞳孔异常消失。雾化吸入的异丙托溴铵可能从面罩漏入同侧眼睛，导致面部无力患者出现瞳孔散大。在重症监护环境中，这种导致瞳孔不等大的良性原因可通过神经学检查结果的侧别、精神状态无改变、无睑下垂及眼外肌运动障碍与钩回疝相鉴别。
