Anizocoria – a diagnostic challenge. Case report
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Pediatric Surgery Students’ Association, Department of Surgery, Faculty of Health Science, Collegium Medicum, University of Warmia and Mazury in Olsztyn
Pediatric Surgery and Urology Clinical Ward, Regional Specialistic Childrens’ Hospital in Olsztyn, Poland
Submission date: 2018-10-17
Final revision date: 2018-12-15
Acceptance date: 2018-12-15
Online publication date: 2019-12-11
Corresponding author
Marta Sophie Stęga   

605 Majors Path, 11968, Southampton, United States
Pol. Ann. Med. 2019;26(2):155-157
Anisocoria is a condition characterized by unequal pupils. There are two described types: physiologic and pathologic. Pathologic anisocoria is caused by interruption in reflex arc. Reason of anisocoria can be difficult to define due to variety of possible diseases that may be causing it.

Case presentation of anisocoria caused by congenital cystic lesions of the brain.

Case Study:
12-year-old girl after head trauma was admitted to the Emergency Department due to anisocoria noticed by family doctor. Patient had headache, sleepiness, dizziness and lacrimation. After looking at patients’ childhood photo it was stated, that anisocoria was present before the injury. In physical examination decreased mobility of left eyeball, left-sided ptosis and left-sided decreased reaction to the light (both, direct and consensual) were noted. Head CT scan was performed, which revealed bilateral cystic lesions in basal ganglia, thalamus and in mesencephalon. The biggest lesions were located in left thalamus – 29x15mm. Biopsy of the biggest cyst was performed. No neoplastic tissue was found. Final diagnosis was stated: diencephalic and mesencephalic polycyclic lesions of unknown origin. Surgical approach was departed and conservative treatment was applied (regular head MRI scans)

Results and discussion:
Described case report was an example of diagnostic difficulties which can be caused by anisocoria. In this case pathologic anisocoria was caused by congenital cystic lesions of the brain that were detected in the age of 12.

Anisocoria can be a sign of many different pathologies, but also can be physiologic. If pathologic anisocoria is suspected, imaging diagnostics should always be performed.

Ettinger ER, Wyatt HJ, London R. Anisocoria. Variation and clinical observation with different conditions of illumination and accomodation. Invest Opthalmol Vis Sci. 1991;32(3):501–509.
Molly E, Gilbert MD, Friedman D. Migraine and anisocoria. Surv Ophthalmol. 2007;52(2):209–212.
Lee KA. Anisocoria after repair of blowout fracture. J Craniofac Surg. 2017;28(5):1289–1290.
Naguib MM, Mendoza PR, Jariyakosol S, Grossniklaus HE. Atypical pituitary adenoma with orbital invasion: Case report and review of the literature. Surv Ophthalmol. 2017;62(6):867–874.
Dahl E. Head injury and anisocoria on a cruise ship. Int Merit Health. 2016;67(3);3:159–160.
Białkowska J, Sowa M, Maksymowicz W. Exploration of assistance and rehabilitation possibilities for neurosurgical patients with late complications after craniocerebral injuries based on one patient case. Pol Ann Med. 2012;19(2):58–62.
Alexiou G, Sfakianos G, Prodromou N. Pediatric head trauma. J Emerg Sh. 2011;4(3):403–408.
Wylie MC, Merritt C, Clark M, Garro AC, Rutman MS. Imaging of pediatric head injury in the emergency department. Ped Emerg Care. 2014;30(10):680–685.
Halley MK, Silva PD, Foley J, Rodarte A. Loss of consciousness: when to perform computed tomography?. Ped Critical Care Med. 2004;5(3):230–233.
King MA, Kanal KM, Relyea-Chew A, Bittles M, Vavilala MS, Hollingworth W. Radiation exposure from pediatric head CT: a bi-institutional study. Ped Radiol. 2009;39(10):1059–1065.
Hamidi H, Faizi F, Rasouly N, Hoshang MM. CT and MRI features of pediatric-aged colloid cysts: Report of two cases. Case Rep Radiol. 2017;2017:2467085.
Medscape. Anisocoria Clinical Presentation: History, Physical, Causes. Updated December 27, 2018. Accessed October 8, 2018.
Furlan J, Sundaram A. Sudden-onset anisocoria in a patient with upper respiratory tract infection. CMAJ. 2014;186(1):57–61.
Taillibert S, Le Rhun E, Chamberlain MC. Intracranial cystic lesions: a review. Curr Neurol Neurosc Rep. 2014;14(9):481.
Sharma V, Prabhash K, Noronha V, Tandon N, Joshi A. A systematic approach to diagnosis of cystic brain lesions. South Asian J Cancer. 2013;2(2):98–101.
Prousalidis J, Tzardinoglou K, Sgouradis L, Katsohis C, Aletras H. Uncommon sites of hydatid disease. World J Surg. 1998;22(1):17–22.
Maqsood AA, Devi IB, Mohanty A, Chandramouli BA, Sastry KV. Third ventricular colloid cysts in children. Ped Neurosurg. 2006;42(3):147–150.
Medscape. Brain Imaging in Colloid Cyst: Practice Essentials, Computed Tomography, Magnetic Resonance Imaging. Updated August 28, 2018. Accessed October 8, 2018.
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