Apart from bilateral wheeze in his chest, rest of the examination remained unremarkable. He had generalised hypertonia and bilateral ankle clonus, which was secondary to pre-existing quadriplegic cerebral palsy. He communicated with his parents, was generally irritable but did not seem to be in any pain and settled intermittently when undisturbed. There was no nystagmus, and it was challenging to assess his ocular movements accurately. The left pupil was dilated as shown in figure 1, and measured 6 mm in diameter with no reaction to light. The pupillary examination revealed right pupil diameter of 3 mm with sluggish reaction to light. He opened both his eyes spontaneously with no ptosis. On the fourth day of admission, he was noted to have unequal pupils. He fought vigorously with administration of nebulisations when awake. He was treated with regular salbutamol and ipratropium bromide nebulisation, but later required intravenous salbutamol (up to 2 µg/kg/min) and aminophylline (1 mg/kg/hour) infusions along with intravenous hydrocortisone. He initially required high-flow nasal cannula oxygen and later continuous positive airway pressure to maintain oxygen saturation and to support his work of breathing. He was treated for LRTI and acute viral-induced wheeze. Clinicians should remember that ipratropium administered through ill-fitting face masks could cause this completely reversible adverse effect. This emphasises the urgency in evaluating unilateral mydriasis to rule out life-threatening conditions. Although ipratropium-induced anisocoria has been reported in children, but to our knowledge none in a child with VP shunt for hydrocephalus. A case of pharmacological anisocoria was diagnosed that resolved completely within 24 hours of discontinuation of ipratropium bromide. An urgent CT scan of the brain did not show any new intracranial abnormality. He developed unilateral mydriasis with absent light reflex during treatment with nebulisers. A 3-year-old boy with a ventriculoperitoneal (VP) shunt for an obstructive hydrocephalus presented with an acute respiratory distress. This unique case highlights an uncommon adverse response to a common mode of treatment that leads to a diagnostic dilemma. The links above will provide you with more detailed information on these medical conditions to help you inform yourself about the causes and available treatments for these conditions.There are several causes for sudden onset unilateral mydriasis, however impending transtentorial uncal herniation needs to be ruled out. Understanding your symptoms and signs and educating yourself about health conditions are also a part of living your healthiest life. The risk of stroke can be reduced by controlling high blood pressure, high cholesterol, diabetes, and stopping smoking.Īt MedicineNet, we believe it is important to take charge of your health through measures such as a living healthy lifestyle, practicing preventative medicine, following a nutrition plan, and getting regular exercise. Treatment may include administration of clot-busting drugs, supportive care, and in some instances, neurosurgery. Symptoms of a stroke may include: weakness, numbness, double vision or vision loss, confusion, vertigo, difficulty speaking or understanding speech.Ī physical exam, imaging tests, neurological exam, and blood tests may be used to diagnose a stroke. A stroke is an interruption of the blood supply to part of the brain caused by either a blood clot (ischemic) or bleeding (hemorrhagic).
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