Anisocoria Workup

Updated: Dec 27, 2018
  • Author: Eric R Eggenberger, DO, MS, FAAN; Chief Editor: Edsel B Ing, MD, MPH, FRCSC  more...
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Workup

Laboratory Studies

Lab studies depend upon the specific etiology.

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Imaging Studies

The use of imaging studies depends entirely upon the underlying cause of anisocoria.

Horner syndrome due to lateral medullary syndrome usually can be confirmed by MRI of the head. Imaging of the entire sympathetic pathway is common in the workup of Horner syndrome. [10]

Carotid dissection may be confirmed with magnetic resonance imaging (MRI) or angiography (MRA), computerized tomography angiography (CTA), contrast angiography, or Doppler ultrasound, depending on the segment involved, the level of suspicion, and the availability of imaging modalities. A T1-weighted MRI with fat saturation through the carotid course is the imaging modality of choice.

Third nerve palsies with pupillary involvement should be presumed compressive in origin. An enlarging or leaking berry aneurysm, if suggested by the presentation, is often the compressive lesion that requires most immediate diagnosis.

The choice of imaging type is dependent on the suspected pathophysiology: a cerebral aneurysm would be best imaged with angiography, while skull-based neoplasms are best demonstrated by MRI. Imaging decisions are best made in consultation with the local radiologist after a discussion including the region and lesion of interest.

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Procedures

Procedures depend upon the specific etiology.

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Histologic Findings

Depends upon the specific etiology

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Other Tests

Pupillometers can be used to accurately measure pupil size under various lighting conditions. [11]

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