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Unilateral mydriasis revealing a neurovascular conflict: a case report
Author(s) -
TRECHOT F,
LEGOU F,
BRAUN M,
ANGIOI K
Publication year - 2011
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2011.326.x
Subject(s) - mydriasis , medicine , ptosis , pupil , neurological examination , oculomotor nerve , anisocoria , pupillary light reflex , ophthalmology , fundus (uterus) , blurred vision , surgery , psychology , neuroscience
Purpose To demonstrate a neuro‐vascular conflict between the right posterior communicating artery and oculomotor nerve (CN III) revealed by an isolated unilateral mydriasis. Methods (patient): A right mydriasis without ophtalmoplegia or ptosis was discovered in a 41 years old patient complaining of blurred vision for 6 months. Direct, consensual and accommodation reflexes were absent in the right eye. Slit lamp and fundus examination were strictly normal in both eyes. Cerebral tomography was also normal. After complete ophthalmologic examination (excluding Adie's pupil, with pilocarpine diluted test) and neurological examination, we concluded to a partial CN III palsy reaching the intrinsic component and she underwent an MRI examination including FIESTA weighted images. Results MRI demonstrated the compression of the right CN III by the right posterior communicating cerebral artery, on its superior median part. Imaging criteria of neuro‐vascular conflict were fullfilled: a direct contact, at right angle, at the level of the first millimetres of the nerve and displacing its course. The results of others clinic and paraclinic investigations did not revealed abnormalities, specifically no infectious or inflammatory diseases. Conclusion We recommend performing an MRI in patients with an isolated and persistent mydriasis.