Search Our Scientific Publications & Authors

J Neurol 2019 Feb 12. Epub 2019 Feb 12.

Department of Neuro-ophthalmology, Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK.

Background: Detection of a relative afferent pupillary defect (RAPD) by the swinging-light test can be challenging in clinical practice (dark eyes, anisocoria, dark environment). We developed a new method of RAPD quantification based on the recording of the infrared pupillary asymmetry (IPA) with a standard optical coherence tomography (OCT) device.

Methods: The diagnostic value of the IPA for detection of the RAPD was determined by receiver-operating characteristic (ROC) curves and area under the curve (AUC). Read More

Harm Reduct J 2018 12 22;15(1):64. Epub 2018 Dec 22.

Vancouver Coastal Health, Vancouver, Canada.

Objective: In midst of the overdose crisis, the clinical features of opioid overdoses seem to be changing. Understanding of the adverse effects of synthetic opioids such as fentanyl is currently limited to clinical settings. Insite, a supervised injection site in Vancouver, Canada, provides an opportunity to better understand illicit drug overdose presentations. Read More

J Neurosci Nurs 2018 Nov 27. Epub 2018 Nov 27.

Questions or comments about this article may be directed to Matthew Marshall, MSc, at He is a Medical Student, King's College, London, England. Ritesh Deo, University of Sheffield, Western Bank, Sheffield S10 2TN, England. Charmaine Childs, PhD MPhil BNurs, Sheffield Hallam University, Collegiate Campus, Sheffield, England. Ali Ali, MBChB FRCP MSc, Sheffield Teaching Hospitals and University of Sheffield, Sheffield, England.

Background: Early neurological deterioration (END) is common after stroke and represents a poor prognostic marker. Manual pupillary assessment to detect END is subjective and has poor interrater reliability. Novel methods of automated pupillometry may be more reliable and accurate. Read More

Int Med Case Rep J 2018 18;11:271-276. Epub 2018 Oct 18.

Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,

Background: Horner syndrome refers to a set of clinical presentations resulting from disruption of sympathetic innervation to the eye and adnexa. Classically, the clinical triad consists of ipsilateral blepharoptosis, pupillary miosis, and facial anhidrosis. Ocular sympathetic denervation may signify life-threatening causes. Read More

J Emerg Med 2019 Jan 9;56(1):e17-e18. Epub 2018 Nov 9.

Division of Adolescent Medicine, The Children's Hospital at Montefiore, Bronx, New York.

J Pediatr Ophthalmol Strabismus 2018 Nov 2;55:e33-e35. Epub 2018 Nov 2.

Anisocoria is a significant finding in several ocular and potentially life-threatening neurological disorders. The angel's trumpet (Datura suaveolens), widely used as a garden plant, is a natural alkaloid with anticholinergic effects containing high levels of scopolamine. The authors present a pediatric case of acute anisocoria secondary to contact with the angel's trumpet plant. Read More

J Stroke Cerebrovasc Dis 2019 Jan 13;28(1):163-166. Epub 2018 Oct 13.

Department of Neurosciences, University of California, San Diego, La Jolla, California. Electronic address:

Background: Acute stroke codes may be activated for anisocoria, but how often these codes lead to a final stroke diagnosis or alteplase treatment is unknown. The purpose of this study was to assess the frequency of anisocoria in stroke codes that ultimately resulted in alteplase administration.

Methods: We retrospectively assessed consecutive alteplase-treated patients from a prospectively-collected stroke registry between February 2015 and July 2018. Read More

Eur J Neurosci 2018 Dec 24;48(11):3379-3388. Epub 2018 Oct 24.

Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada.

The pupil constricts or dilates in response to a luminance increase or decrease, and these transient pupillary responses are controlled by the parasympathetic and sympathetic pathways. Although pupillary responses of the two eyes are highly correlated, they are not always identical (referred to as anisocoria). For example, there are unequal direct and consensual pupillary constriction responses after an increase in luminance to one eye. Read More

Int J Pediatr Otorhinolaryngol 2018 Nov 23;114:9-14. Epub 2018 Aug 23.

Department of Otolaryngology, Audiology and Phoniatrics, Pediatric Cochlear Implant Center, Children's Hospital of Bydgoszcz, Poland.

Schwannomas arising from the vagus nerve are extremely rare in children, with only 15 cases reported in the world literature. We describe a pediatric case of cervical vagal nerve schwannoma successfully treated with cranial nerve-sparing surgery. Our patient presented extensive mass in the right side of the neck with ipsilateral Horner's syndrome. Read More

World Neurosurg 2018 Dec 21;120:430-434. Epub 2018 Sep 21.

Department of Neurosurgery, Maharaja Agrasen Medical College, Agroha, India.

Background: Treatment of arteriovenous malformations (AVMs) is currently performed at specialized neurosurgical centers well equipped with microscopes with green filters, neurosurgical catheterization laboratories, and experienced neurosurgical teams. Patients in whom AVMs are diagnosed at smaller hospitals should be referred to such specialized centers. This case report describes the unavoidable worst-case scenario of an emergency unplanned surgical excision of an undiagnosed ruptured AVM with large hematoma. Read More

J Spinal Cord Med 2018 Aug 20:1-4. Epub 2018 Aug 20.

a Department of Physical Medicine and Rehabilitation , Penn State Health Milton S. Hershey Medical Center , Hershey , Pennsylvania , USA.

Context: Autonomic dysreflexia and dysautonomia can be a common complication following spinal cord injury, especially at levels of T6 and above and can lead to complications associated with the pupil. In this case report, we review autonomic dysreflexia, the anatomy and physiology of the sympathetic nervous system of the eye, as well as review the clinical relevance in understanding autonomic and pupillary changes in response to autonomic dysfunction.

Findings: We present a patient with an incomplete C4 level injury who was found to have isolated anisocoria on two separate occasions during his acute inpatient rehabilitation stay. Read More

Int J Appl Basic Med Res 2018 Jul-Sep;8(3):190-192

Department of Orbit and Oculoplasty, Sankara Netralaya, Chennai, Tamil Nadu, India.

Horner's syndrome is characterized by triad of blepharoptosis, miosis, and anhydrosis on the lateral part of the face. Incidence of iatrogenic Horner syndrome resulting from neck surgeries has been reported between 10% to 18.5%. Read More

Int J Appl Basic Med Res 2018 Jul-Sep;8(3):155-157

Department of Opticianry, Uskudar University, Istanbul, Turkey.

Purpose: The purpose of this study is to detect the changes in pupil size developing after phacoemulsification surgery.

Methods: Seventy-five eyes of a total of 49 patients (32 males and 17 females) were included in this prospective clinical trial. Routine preoperative ophthalmological examinations of the patients were performed. Read More

Rev Med Liege 2018 Jul;73(7-8):428-432

Service d'Ophtalmologie, CHU Sart Tilman, Liège, Belgique.

We report four cases of painful Horner's syndrome due to carotid artery dissection. A lesion on oculosympathic pathway causes Horner's syndrome. A painful Horner's syndrome needs a prompt exploration by tomodensitometry or magnetic resonance imaging to exclude carotid artery dissection. Read More

Pediatr Emerg Care 2018 Aug;34(8):599-601

Department of Emergency Medicine and Trauma Center, Meyer University Children's Hospital, Florence, Italy.

An 18-month-old girl presented to the emergency department with the chief complaint of squinting. The right eye demonstrated esotropia, heterochromia, and anisocoria. Ocular point-of-care ultrasound facilitated the rapid diagnosis of retinoblastoma, which was confirmed by computed tomography scan and orbital magnetic resonance imaging. Read More

J Refract Surg 2018 Jul;34(7):482-488

Purpose: To analyze stereoscopic vision under a broad range of experimental conditions simulating small-aperture corneal inlay and monovision conditions.

Methods: A total of 10 patients participated in the study. The anisocoria generated by corneal inlays was simulated by using a small-aperture contact lens fitted on the non-dominant eye. Read More

BMJ Case Rep 2018 Jun 27;2018. Epub 2018 Jun 27.

Department of Comprehensive Strokology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.

A dural arteriovenous fistula (DAVF) presenting with acute subdural haematoma (ASDH), which were not related to head injury, is rare. A 61-year-old woman was transported by ambulance because of deterioration of consciousness. On admission, she was comatose with anisocoria. Read More

Arq Bras Oftalmol 2018 Jun;81(3):195-201

Nucleus of Tropical Medicine, Universidade de Brasília, Brasília, DF, Brazil.

Purpose: We investigated parasympathetic innervation abnormalities of the iris sphincter and ciliary muscles in chronic Chagas disease by measuring pupillary diameter and intraocular pressure.

Methods: A group of 80 patients with Chagas disease was compared with 76 healthy individuals without chagasic infection. The following procedures were performed: pupillometry, hypersensitivity test to pilocarpine 0. Read More

J Clin Psychopharmacol 2018 08;38(4):397-398

Neurosciences Research Centre Molecular and Clinical Sciences Research Institute St George's University of London London, United Kingdom and Institute of Psychiatry and Psychology Fondazione Policlinico Universitario "A.Gemelli," Università Cattolica del Sacro Cuore Rome, Italy Neurosciences Research Centre Molecular and Clinical Sciences Research Institute St George's University of London London, United Kingdom.

Open Vet J 2018 26;8(2):186-192. Epub 2018 May 26.

Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53706, USA.

The cavernous sinus (CS) is a paired venous sinus that runs along either side of the pituitary gland on the floor of the calvarium. Cavernous sinus syndrome (CSS) refers to deficits in more than one of the cranial nerves III, IV, V, and VI, as they are in close association in this region. The purpose of this study was to identify the presenting complaints, neurologic findings, diagnosis, and outcomes in dogs and cats with confirmed cavernous sinus syndrome (CSS). Read More

Comp Med 2018 Aug 15;68(4):319-323. Epub 2018 Jun 15.

Animal Care Sciences, Smithsonian Institution National Zoological Park, Smithsonian Conservation Biology Institute, Washington, DC.

A 20-y-old male intact white-faced saki monkey (Pithecia pithecia) presented with an acute ocular disease of the right eye. Clinical signs included periocular swelling, conjunctivitis, and anisocoria with a miotic right pupil. Conjunctival swabs were positive for Human herpesvirus 1 (HHV1) according to PCR amplification with sequencing. Read More

Pediatr Emerg Care 2018 Jun;34(6):e111-e114

Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN Departments of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, TN Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN

Open Vet J 2018 29;8(2):144-148. Epub 2018 Apr 29.

Dick White Referrals, Station Farm, London Road, Six Mile Bottom, Cambridgeshire CB8 0UH, UK.

The purpose was to describe a case of retrobulbar steatitis and meningitis in a cat caused by otitis media, otitis interna and an inflammatory polyp in the middle ear. Investigations included ophthalmic and neurological examinations, haematology and biochemistry, magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) analysis and aerobic, anaerobic bacterial and fungal culture of material from the middle ear. A 6-year-old female neutered domestic-short-haired cat presented with right-sided exophthalmos and resistance to retropulsion. Read More

Methodist Debakey Cardiovasc J 2017 Oct-Dec;13(4):243-247

HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS.

Dissection of the internal carotid artery (ICA) accounts for 5% to 25% of ischemic strokes in young adults. We report a case of spontaneous recanalization of a traumatic ICA dissection in which carotid duplex (CDU) and transcranial color-coded duplex ultrasound (TCCD) were used. A 47-year-old male presented with intermittent episodes of headache, blurry vision, anisocoria, and loss of taste sensation following a whiplash injury while body surfing. Read More

Am J Ophthalmol Case Rep 2018 Jun 15;10:128-131. Epub 2018 Feb 15.

Department of Ophthalmology, Stanford School of Medicine, 2452 Watson Court, Palo Alto, CA 94303-5353, USA.

Purpose: Midline structural defects in the neural axis can give rise to neuro-ophthalmic symptoms. We report a rare case of keyhole aqueduct syndrome presenting after two years of severe cough due to gastroesophageal reflux disease.

Observations: A 58-year-old woman with a 2-year history of daily, severe cough presented to the neuro-ophthalmology clinic with progressive diplopia and oscillopsia. Read More

J Pediatr Neurosci 2017 Oct-Dec;12(4):332-337

Department of Anaesthesiology, Sher-I Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.

Introduction: Traumatic brain injury (TBI) in children is a significant cause of morbidity and mortality worldwide. Falls are the most common type of injury, followed by motor vehicle-related accidents and child abuse.

Aims And Objectives: The aim and objective of this study was to elucidate the various modes of injury, prognostic factors, complications, incidence of various modes of injury, and outcome in TBI in pediatric population. Read More

No Shinkei Geka 2018 Mar;46(3):227-234

Department of Neurosurgery, Kyoto First Red Cross Hospital.

Introduction: Decompressive craniectomy(DC)with craniotomy for acute epidural hematoma(AEDH)removal is controversial. Here, we summarized two difficult AEDH cases where DC was performed. CASE 1:A 26-year-old man sustained a head injury in a bicycle accident, with a Japan Coma Scale(JCS)score of 200, right pupil mydriasis, and a left decerebrate posture on admission. Read More

Asian J Neurosurg 2018 Jan-Mar;13(1):56-58

Department of Neurosurgery, Penang General Hospital, Penang, Malaysia.

Dengue fever has been a major cause of morbidity and mortality in subtropical and tropical countries. We report a rare case of severe dengue with spontaneous intracranial hemorrhage. A search of literature through PubMed revealed that the largest series analyzed so far only included five cases. Read More

BMC Vet Res 2018 Feb 27;14(1):60. Epub 2018 Feb 27.

Department of Veterinary Clinics, UPVet, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), Rua Jorge Viterbo Ferreira 228, 4050-313, Porto, Portugal.

Background: In birds there are reports of intracranial lesions but not of the clinical, computed tomographic and histopathologic features of acute intraparenchymal cerebral haemorrhage in Iberian golden eagle.

Case Presentation: The following report describes a case of a 30-year-old Iberian golden eagle (Aquila chrysaetos homeyeri) with no history of trauma, presented with acute opisthotonus, left head tilt and circling, anisocoria, positional nystagmus, and ataxia. The main differential diagnosis were hypovitaminosis B or E and intracranial disease due to trauma, infection, toxins or masses. Read More

Can J Ophthalmol 2018 02 8;53(1):e6-e7. Epub 2017 Nov 8.

Blanton Eye Institute, Houston Methodist Hospital, Houston, TX.

Clin Ophthalmol 2018 4;12:85-89. Epub 2018 Jan 4.

Western University of Health Sciences, College of Optometry, Pomona, CA, USA.

Purpose: To evaluate the measurement of anisocoria in a group of ocular healthy subjects using a standardized protocol in scotopic, mesopic, and photopic lighting conditions, and determine the optimal threshold of difference in pupil diameter in determining physiologic anisocoria.

Methods: Right and left pupil diameters of 126 ocular healthy subjects with a mean age 30.5±7. Read More

J Ophthalmol 2017 4;2017:7575040. Epub 2017 Dec 4.

Department of Ophthalmology, University Hospital Zurich, Frauenklinikstrasse 24, CH-8091 Zurich, Switzerland.

Background: Evaluation of anisocoria including pharmacological testing for Horner's syndrome in the pediatric population is challenging in view of potential serious underlying disease. We describe cocaine test results, outcome of systemic investigation, and long-term follow-up in children with anisocoria.

Methods: Retrospective review of medical records and phone interview of consecutive pediatric patients (<18 years old) who underwent cocaine testing from August 2007 to July 2015 at a tertiary referral centre. Read More

Neuroophthalmology 2017 Oct 8;41(5):241-246. Epub 2017 May 8.

Husie Health Centre, Department of General Practice, Skane University Hospital, Malmö, Sweden.

We previously reported that some healthy individuals show alternating anisocoria. We now describe one such individual who also exhibits a classic nasal cycle (alternating periods of nasal congestion and decongestion). We made measurements of his pupil asymmetry and nasal asymmetry at 21 different time points and found that these variables were always synchronised such that greater nasal airflow was invariably found on the same side as the larger pupil. Read More

BMC Pediatr 2018 01 15;18(1). Epub 2018 Jan 15.

Department of Pediatrics, Medizinische Fakultät, Technische Universität Dresden, Dresden, Germany.

Background: Triple A syndrome (or Allgrove syndrome) is a rare autosomal recessive disorder characterized by alacrima, achalasia, adrenal insufficiency and autonomic/neurological abnormalities. The majority of cases are caused by mutations in the AAAS gene located on chromosome 12q13. However, the clinical picture as well as genetic testing may be complex since symptomatology is variable and mutations cannot be identified in all clinically diagnosed patients. Read More

J Neuroophthalmol 2018 Mar;38(1):52-53

Department of Neuro-Ophthalmology, University of Lausanne, Hôpital Ophtalmique Jules Gonin, Lausanne, Switzerland.

This Invited Commentary discusses the following article: BACKGROUND:: To identify the etiologies of adult Horner syndrome (HS) in the MRI era using a targeted evaluation approach and to assess the value and yield of targeted imaging.

Methods: A retrospective chart review was performed of 200 adult outpatients with HS, confirmed with cocaine eyedrop testing. Patients were divided into subgroups based on the presence or absence of symptoms and those who did or did not receive additional testing with hydroxyamphetamine drops. Read More

Arch Dis Child 2018 Nov 4;103(11):1090. Epub 2018 Jan 4.

Department of Paediatrics, Salisbury District Hospital, Salisbury, UK.

ACS Chem Neurosci 2018 02 20;9(2):177-186. Epub 2017 Dec 20.

Department of Ophthalmology, Wake Forest University School of Medicine , Wiston-Salem, North Carolina 27157, United States.

Horner syndrome results from an interruption of the oculosympathetic pathway. Patients with Horner syndrome present with a slightly droopy upper lid and a smaller pupil on the affected side; less commonly, there is a deficiency of sweating over the brow or face on the affected side. This condition does not usually cause vision problems or other significant symptoms, but is important as a warning sign that the oculosympathetic pathway has been interrupted, potentially with serious and even life-threatening processes. Read More

Am J Ophthalmol Case Rep 2017 Sep 12;7:11-13. Epub 2017 Apr 12.

Department of Pulmonology, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina.

Purpose: We present a case report of a 44-year old female patient with complicated pneumonia who developed anisocoria after treatment with inhaled ipratropium bromide. Discontinuation of ipratropium bromide treatment led to complete resolution of anisocoria.

Observation: A 44-year old female patient was admitted to the Department of Pulmonology due to high body temperature (40. Read More

Medicine (Baltimore) 2017 Dec;96(49):e9038

Department of Neurosurgery, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang, China.

Rationale: The superior sagittal sinus (SSS) and transverse sinus are the major dural sinuses that receive a considerable amount of venous drainage. The occlusion of them has been suggested to cause intracranial hypertension, hemorrhage, and lead to potentially fatal consequences.

Patient Concerns: We reported a 35-year-old woman with headache presented to our emergency department with a decreased level of consciousness and epileptic seizures. Read More

Neurology 2018 Jan 8;90(2):86-88. Epub 2017 Dec 8.

From the Hospital of the University of Pennsylvania (E.C.C., I.J., G.T.L.), Philadelphia; Children's Hospital of Philadelphia (I.J., G.T.L.), PA; and University of Iowa and Veterans Administration (R.K.), Iowa City.

Arch Bronconeumol 2018 Aug 6;54(8):437-439. Epub 2017 Dec 6.

Servicio de Neurología, Hospital Vithas Xanit Internacional, Málaga, España.

Acute Med Surg 2017 10 17;4(4):451-453. Epub 2017 Jul 17.

Department of Neurosurgery Okitama Public General Hospital Yamagata Japan.

Case: The standard treatment for acute subdural hematoma (ASDH) is large craniotomy; decompressive craniectomy may also be carried out, if needed, to prevent secondary brain damage. Recently, an endoscopic procedure for elderly patients with ASDH was carried out and reported; its safety and effectiveness were emphasized because of minimal invasiveness. We report a young case and discuss its difficulties and tips. Read More

Oman J Ophthalmol 2017 Sep-Dec;10(3):225-227

Department of Ophthalmology, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece.

A 38-year-old woman with advanced keratoconus initially developed Urrets-Zavalia Syndrome (UZS) in the left eye after deep anterior lamellar keratoplasty. During the uneventful surgery, a 7-mm-wide pupil unresponsive to light was noticed. On the first postoperative day, intraocular pressure (IOP) was elevated up to 45 mmHg with shallow anterior chamber (AC). Read More

Int Ophthalmol 2018 Dec 1;38(6):2689-2692. Epub 2017 Nov 1.

Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK.

Purpose: To describe the good outcome of implantable collamer lens (ICL) rotation to reduce post-operative vault.

Methods: Retrospective analysis of case report. A 43-year-old woman had V4c EVO + myopic non-toric ICL implantation and post-operatively she presented with anisocoria and high vault. Read More

Am J Med 2018 Feb 24;131(2):120-128. Epub 2017 Oct 24.

Brigham and Women's Hospital, Harvard Medical School, Boston, Mass. Electronic address:

Visual symptoms, including acute monocular visual loss, papilledema, visual field deficits, anisocoria, limitations of eye movements, and nystagmus, can be the presenting feature of a wide range of important neurologic diseases. It is important for primary care clinicians to be to be able to direct appropriate initial diagnostic assessment, treatment, and referral for further evaluation of these conditions. Read More

Ophthalmology 2017 11;124(11):1669

Neuro-ophthalmology Department, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.

Clin Med Res 2017 Dec 17;15(3-4):93-95. Epub 2017 Oct 17.

Department of Ophthalmology, Marshfield Clinic - Marshfield Center, Marshfield, Wisconsin, USA.

A woman, aged 70 years, developed anisocoria after applying homeopathic eye drops (Similasan Pink Eye Relief) to her left eye. Her pupil was dilated for two weeks and did not respond to light or near stimuli for one week. Both 0. Read More

Am J Emerg Med 2017 Dec 5;35(12):1988.e3-1988.e5. Epub 2017 Oct 5.

Department of Emergency Medicine, Department of Medicine, Chungbuk National University, Cheongju, Republic of Korea. Electronic address:

Acute non-traumatic headaches with neurological deficits alarm emergency department (ED) physicians. Typically, a sudden headache with oculomotor nerve palsy involving a pupil indicates the possibility of a subarachnoid hemorrhage (SAH) due to an aneurysm originating from the posterior communicating artery. For the ED physician, thinking beyond the possibility of an SAH can be crucial. Read More

Ocul Immunol Inflamm 2018 13;26(1):104-106. Epub 2017 Oct 13.

a Department of Uveitis and Ocular Inflammation , Vittala International Institute of Ophthalmology & Prabha Eye Clinic and Research Center , Bangalore, India.

Purpose: To report an interesting case of development of tonic pupil in an immunocompetent male with cytomegalovirus (CMV) anterior uveitis.

Methods: Retrospective case report Results: A 30-year-old Iranian healthy male was diagnosed to have Posner-Schlossman syndrome (OS). Aqueous tap was positive for CMV by multiplex Polymerase chain reaction (PCR). Read More