Isolated Contralateral Mydriasis following Traumatic Intraparenchymal Hematoma: A Case Report

Abstract

Pupillary dilation is a localizing sign for ipsilateral intracranial space occupying lesion with uncal herniation. However, this may not always be true and further evaluation may be needed before localizing a lesion in case of unilateral mydriasis. There is limited literature supporting the occurrence of isolated contralateral pupillary dilation in traumatic intraparenchymal hematoma. We report a case of pupillary dilation on the contralateral side in a patient with temporal hematoma following traumatic brain injury. The available literature is reviewed and possible mechanisms discussed. The patient presented after 5 hours of road traffic accident with temporal contusion. Emergency craniotomy was done and contusion evacuated. The patient recovered well, but mydriasis persisted. Unilateral fixed dilated pupil might act as a false localizing sign in patients with supratentorial intra-axial lesion. Physicians managing critically ill neurologic and neurosurgical patients must be aware of such an occurrence.

Keywords

mydriasis - false localizing sign - traumatic brain injury - temporal hematoma - uncal herniation

Consent for Publication

Written informed consent has been taken from the patient for publication of details as case report.

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