Episodic unilateral mydriasis after neck trauma

Abstract

A 29-year-old male without history of migraine developed, after whip-lash injury, episodic unilateral mydriasis lasting for several hours to a few days with a frequency of 1-2 times a week. It appeared separately on both sides associated ipsilaterally with blurred vision and moderate headache, but without other neurological or autonomic deficits. The mydriatic pupil of 7-9 mm showed sluggish or absent pupillary reactions in room light, but mostly further dilatation with prompt reactions of a slight degree in semi-darkness, and constriction after 0.5% pilocarpine instillation. During the non-mydriatic phase, it did not react to 1.25 % epinephrine, but failed to be dilated by 4% tyramine, suggesting postganglionic oculosympathetic deficit.

Key Words:

• episodic unilateral mydriasis
• whiplash injury
• postganglionic oculosympathetic deficit