Parasympathetic and sympathetic pupillary involvement in inflammatory parasellar lesions

Abstract

We evaluated pupillary abnormalities in three patients with intracranial inflammatory lesions in which the parasellar region was involved. In two patients, the pupil on the affected side was moderately mydriatic, poorly reactive to light and near stimuli, but relatively smaller in semi-darkness. In the third patient, parasympathetic paresis was not evident, but the pupil of the affected side showed dilation lag in semidarkness. In all patients, the pupil on the affected side showed greater mydriatic response to 1.25% epinephrine. These findings indicate that parasellar inflammatory lesions may cause simultaneous ocular parasympathetic and sympathetic paralysis, and that the degree of impairment may be as variable as in compressive lesions such as meningioma or aneurysm in the cavernous sinus.

Key Words:

• Parasellar lesion
• Inflammation
• Pupil
• postganglionic sympathetic dysfunction