Shah Janki, Jiang Alice, Fekete Zoltan
Graduate Medical Education, Orange Regional Medical Center, Middletown, New York, USA.
Crystal Run Healthcare, Rock Hill, New York, USA.
BMJ Case Rep. 2017 Sep 19;2017:bcr-2017-221677. doi: 10.1136/bcr-2017-221677.
A unilaterally fixed mydriasis, also known as a 'blown pupil,' is considered an ominous sign concerning for intracranial pathology. Causes of anisocoria can range from benign to immediately life-threatening. When a patient presents with anisocoria, the concern for a fatal diagnosis leads the clinician to obtain numerous tests, many of which may be unnecessary. The authors present a case of a healthy woman in her 30s who presented with an acute unilateral mydriasis likely secondary to inadvertent contact with a scopolamine patch. On examination, she had no other neurological deficits. Further investigation did not reveal any abnormality. In the event of a patient with an isolated mydriasis in an otherwise healthy and conversant patient with no other neurological deficits, it is essential to rule out other causes before pursuing aggressive and unnecessary testing and treatment.
单侧固定性瞳孔散大，也称为“瞳孔扩大”，被认为是颅内病变的不祥征兆。瞳孔不等大的原因从良性到即刻危及生命不等。当患者出现瞳孔不等大时，对致命诊断的担忧会促使临床医生进行大量检查，其中许多检查可能是不必要的。作者介绍了一例30多岁健康女性的病例，该患者出现急性单侧瞳孔散大，可能是因无意中接触了东莨菪碱贴片所致。检查发现，她没有其他神经功能缺损。进一步检查未发现任何异常。对于原本健康、意识清醒且无其他神经功能缺损的单纯瞳孔散大患者，在进行积极且不必要的检查和治疗之前，排除其他原因至关重要。
