Diagnosis of anisocoria
The diagnosis of anisocoria can be made by a so-called gaze diagnosis. Therefore, one does not need any instrumental examinations to detect anisocoria. In order to determine the extent of the disorder, a test with the pupil light is usually carried out.
In this test, the affected person is first illuminated in one eye, the pupils of both eyes should contract. The test is then performed on the other eye. Depending on the location of the disorder (conduction path from the eye to the brain or from the brain to the pupil muscles), the pupils react differently.
Further diagnostics can be performed to determine the exact cause of the disturbed pupil function. The anamnesis plays a particularly important role in this process, where possible triggers for anisocoria can be inquired. If necessary, an imaging of the skull may be necessary.
An MRI of the head is required if the cause of anisocoria in the brain is suspected. In the case of suddenly occurring pupillary disturbances, one initially assumes an acute event such as a brain injury, bleeding or stroke. In this case, a CT of the skull is performed first, since this examination is much faster (a few minutes) than an MRI (20 to 30 minutes) and time plays an important role in the prognosis of brain tissue in the event of an acute danger.
If no acute problem can be suspected, an MRI of the head is usually performed. This can also reveal small lesions (damage) such as bleeding or space-occupying. The MRI is particularly suitable for tumour searches, as this type of imaging is able to show the brain tissue particularly well.
Accompanying symptoms of amisocoria
The accompanying symptoms of anisocoria are strongly dependent on the cause of the symptoms. Sudden processes such as bleeding or a stroke are often accompanied by equally acute disorders of other brain functions and often manifest themselves by an inability to move certain muscle groups (facial muscles, arm muscles, leg muscles, pharyngeal muscles = speech disorders). These dysfunctions are usually one-sided, since bleeding or reduced supply to the brain also occurs on only one side.
With slower processes such as a brain tumour or increased brain pressure due to disturbances in the removal of brain water, no such acute symptoms occur. Instead, the accompanying symptoms become gradually apparent. Often, the first symptoms are
- Recurring headaches.
- Blurred vision,
- And vomiting can be triggered by the increased pressure in the skull. Migraine is a type of headache that occurs suddenly and is accompanied by other symptoms such as nausea or visual disturbances. The pain is usually located on one half of the head, but can change from migraine attack to migraine attack between the sides.
It is not unusual for so-called prodromi (signs) to occur before the onset of migraine. These manifest themselves in the form of mood swings, fatigue, concentration problems, etc. During the migraine attack, affected persons are often sensitive to smell, light and noise, and a so-called aura in the form of visual disturbances can also occur. In addition, individual functions can be disturbed, which can manifest itself in the form of eye tears, anisocoria, dizziness and vomiting.