Anisocoria (Differential Diagnosis as before)

Figure comm_18a_n.jpg to comm_18c_n.jpg: Different causes of anisocoria. Figure comm_18a_n.jpg: An anisocoria like in this 5-year-old girl may be an ominous sign following head injury due to a tentorial herniation of the uncus with third nerve palsy (unilateral space-occupying mass of one hemisphere by an epidural hematoma or a cerebral contusion). In this girl a pre-existing anisocoria of unknown origin is present; among many other possible causes it may be a transient neurological sign in atypical concussion, or due to the application of a mydriatic. Figure comm_18b_n.jpg: In this 14.7-year-old boy with severe head injury (GCS 8 or less) the left pupil is dilated and unresponsive due to an irreversible herniation in a temporo-parietal focus of a cerebral contusion with brain edema 24 hours after a vehicular accident. Figure comm_18c_n.jpg: A similar situation is present in this toddler with a dilated, only partially round and unresponsive right pupil due to a herniation on the right side in progressive shunt dysfunction.