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Anisocoria from transdermal scopolamine.

Y C Lin1

  • 1Department of Anesthesia, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA. lin_yu@tch.harvard.edu

Paediatric Anaesthesia
|November 7, 2001
PubMed
Summary

Transdermal scopolamine patches effectively manage motion sickness and opioid withdrawal. However, this case highlights a rare side effect: anisocoria, a dilated pupil, caused by the patch in a young patient.

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Area of Science:

  • Pharmacology
  • Neurology
  • Infectious Diseases

Background:

  • Transdermal scopolamine patches are commonly used for motion sickness, chemotherapy-induced nausea/vomiting, and opioid withdrawal.
  • A 14-year-old boy with chronic granulomatous disease presented with severe shoulder pain due to Aspergillus infection.
  • High-dose opioid analgesia was initiated for pain management.

Observation:

  • A unilateral fixed and dilated pupil (anisocoria) was observed in the patient.
  • Initial suspicion pointed towards central nervous system aspergillosis.
  • Neurological workup was performed to investigate the cause of anisocoria.

Findings:

  • The anisocoria was ultimately attributed to the transdermal scopolamine patch.
  • This represents an unusual adverse effect of scopolamine in this clinical context.
  • The patch was prescribed to manage opioid withdrawal symptoms.

Implications:

  • Clinicians should consider transdermal scopolamine as a potential cause of anisocoria, especially in patients with risk factors.
  • This case underscores the importance of a thorough medication review in diagnosing neurological signs.
  • Further investigation into the mechanism of scopolamine-induced anisocoria may be warranted.

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