What happens to pupils with head injury?

Objective: Acute pupillary dilation in a head-injured patient is a neurological emergency. Pupil dilation is thought to be the result of uncal herniation causing mechanical compression of the IIIrd cranial nerve and subsequent brain stem compromise.

What can cause afferent pupillary defect?

Retinal Causes of a Relative Afferent Pupillary Defect Ischemic retinal disease: Causes include ischemic central retinal vein occlusion, central retinal artery occlusion, severe ischemic branch retinal or arterial occlusions, severe ischemic diabetic or sickle-cell retinopathy.

Can a head injury cause pinpoint pupils?

Head injury For people who have sustained head injuries in road-traffic or other accidents, pinpoint pupils can be a sign of serious internal problems. Head injuries can cause severe and even life-threatening complications, even if the effects are not immediately apparent.

Can a concussion cause Horner syndrome?

If the trauma damages the sympathetic nervous system pathway anywhere from the hypothalamus to the eye, the patient will present with Horner syndrome, which includes miosis and ptosis on the affected side.

Why are pupils unequal after head injury?

Concussion of the brain may cause unequal pupils if the injury affects certain areas of the brain. Additionally, when the skull comes to a sudden stop, the brain can not only be injured on the side that has been impacted, but on the opposite side as well, as the brain bounces back.

How do you test for an afferent pupillary defect?

The ‘swinging light test’ is used to detect a relative afferent pupil defect (RAPD): a means of detecting differences between the two eyes in how they respond to a light shone in one eye at a time.

What does it mean if your pupils are sluggish?

A sluggish pupil may be difficult to distinguish from a fixed pupil and may be an early focal sign of an expanding intracranial lesion and increased intracranial pressure.

What causes unequal pupils in head trauma?

What does it mean if pupils are unresponsive?

Abnormalities such as an irregular pupil size or shape, or a delayed or nonreactive pupil can be indicative of significant head trauma. A score of 2 means both pupils are non-reactive to light; a score of 1 means one pupil is non-reactive; and a score of 0 means neither pupil is non-reactive.

What does Horner’s syndrome look like?

Drooping of the upper eyelid (ptosis) Slight elevation of the lower lid, sometimes called upside-down ptosis. Sunken appearance to the eye. Little or no sweating (anhidrosis) either on the entire side of the face or an isolated patch of skin on the affected side.

What can cause a relative afferent pupillary defect?

Other Causes of a Relative Afferent Pupillary Defect. Amblyopia: If severe, can lead to a relative afferent pupillary defect. Usually the visual acuity would be 20/400, or worse. Cerebral vascular disease: Usually, it is an optic nerve disorder that leads to an RAPD, rather than an optic tract or visual cortex disorder.

Can a pupillary defect cause traumatic optic neuropathy?

Pupillary reaction: An afferent pupillary defect (APD) is a necessary condition for the diagnosis of traumatic optic neuropathy. Normally, light in one eye causes equal constriction of both pupils (direct and consensual pupillary light reflex).

Can a central Horner syndrome cause pupil efferent defects?

Pupil Efferent Defects. In a central Horner syndrome there will often be associated neurological findings. The presence of ataxia, skew deviation, nystagmus, and hemisensory deficit, for example, would strongly suggest a medullary lesion and magnetic resonance imaging (MRI) of the brain would be recommended.

How can you tell if there is a pupillary defect?

Using the swinging light test, physicians test and observe the pupillary response to consensual light in order to determine if there is a defect present. Normally, the pupil constriction does not change as the light is swung from eye to eye. When the light is moved quickly from eye to eye, both pupils should hold their degree of constriction.