Saturday, September 17, 2011

What The...???

So, I have unequal pupils. This has been happening for several years now, but this recent stint has lasted about a week with no real neurological symptoms. (Usually, this is accompanied by a migraine or other neurological problems like drooling, aphasia, photophobia and phonophobia. What I have noticed is that I am having trouble seeing out of my right eye, and it's the eye I usually have the constricted pupil and supervision in, but my smaller pupil is the left eye this time, and I can see out of it just fine.

The picture above is a bit exaggerated. Here is a pic of what the size difference looks like in my eyes. I can't exactly get a pic of my own eyes due to the flash.
It is noticeable enough, but not like the first picture.

These episodes of unequal pupils concern me for several reasons. Allow me to list them.

  • Changes in pupil size and unequal pupil size can occur with serious conditions such as head trauma (concussions), brain tumors, stroke/TIA (Transient Ischemic Attack) or poisoning.
  • Increased intracranial pressure
  • Seizures (effects can last long after)
  • Infection of membranes (around the brain itself)
  • Brain tumor or brain abscess
  • Glaucoma
  • Tumor or mass in the chest
  • Horner's Syndrome (I may have that because at my eye appointments, when the doctor dilates my eyes and takes pictures of them, even both pupils dilated are not the same size and my eyelid does droop (ptosis) noticeably in the photographs there. I pointed this out, and he wasn't concerned, but I noticed this in 2008/2009. The only other explanation for ptosis is neurological.)
  • Aneurysm
  • Brain hemorrhaging/bleeds
  • Migraine Headaches (I have not had a migraine for a while now and I don't have a migraine at the present time.)
Okay, Differential diagnosis for unequal pupils. Go.

What issues can be ruled out in this case?

  • I am a female in my early *twirties* to be exact, so I wouldn't have glaucoma.
  • Infection can be ruled out because I have no symptoms to support an infection. Usually fever is a big indicator in something like that.
  • Increased Intracranial Pressure is not likely. I haven't had an actual headache, including migraines, for I want to say around three to four months. I have had weakness and numbness on one side of the body that did not accompany a migraine a day or two ago, but no double vision, behavioral changes, decreased consciousness, or lethargy, so pretty good chance that's not it.
  • Tumor or mass in the chest...that can be ruled out. The only symptom there is hoarseness, but my allergies have been on the rise the last week or two.
  • Aneurysm, probably can rule it out. I don't have a headache or pain behind an eye, but I do have ptosis and vision problems. Without the headache or sudden onset of symptoms, it's highly unlikely.
  • Brain hemorrhage has approximately fifteen symptoms, and I experience thirteen of those during a migraine, including loss of consciousness and impeded swallowing.
  • Horner's Syndrome is a big maybe. I have partial ptosis, miosis, and red conjunctiva. I don't know. It's not painful, so if this is the case, I'll take a syndrome with no painful or neurological symptoms.
  • Migraine headache can be ruled out because I am not having one at this time. My migraines mimic a stroke. No kidding.
  • Brain abscess can be ruled out. I'm at the correct age to have a brain abscess, but I am not immunocompromised nor am I on chemotherapy. (Some patients undergoing chemo are at risk for a brain abscess.)
  • I haven't had any recent head trauma (other than thoughts of ramming my head against a wall repeatedly due to stress) at all...
We have ruled out the majority. Now let's take a look at what wasn't ruled out.

  • Stroke. I haven't had any episodes of that nature from a migraine, but the one sided numbness/weakness that happened two days ago could have been from a TIA. I've been told by several doctors that I am a high stroke risk. (I think STRESS would have something to do with it, especially right now. *lol*)
  • Brain tumor. I am concerned about this sort of thing given all of the neurological issues I have gone through or go through on a fairly regular basis. I would like to think that if I had one, a CT Scan would have revealed it, but I've been told MRI's get a better look at strokes/brain tumors if evidence is present, and nobody wants to do one.
  • Idiopathic. (Unknown cause)
We have listed everything on the so called white board. Too bad I don't have Chase, Cameron, and Foreman to throw out ideas/suggestions. (I'm a bit loyal to the original cast of House M.D.)

So, anyone want to take a dekko at this, try to "solve the puzzle" so to speak? If you can, please let me know.

Until Whenever...


  1. Ooooh, this IS interesting. Are you followed by a neurologist? I would say your migraines are likely hemiplegic migraines (which has a genetic cause)...or maybe basilar migraines. If it is hemiplegic migraine, then you can have some of the symptoms without the pain. Maybe that is what is going on? Here's some good info on anisocoria, with a handy little flowchart to help diagnose it!

  2. Hi Kyla, thank you for commenting. (It's sad that I didn't notice this a few days ago, but I'm only on the internet for so long.)

    No, I'm not followed by a neurologist unfortunately. (I wish.)

    My mom has Adies Pupil with no ptosis.

    Thanks for the link. I'm going to go check it out.