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The abnormal pupil in Cheyne-Stokes respiration. Case report
1Department of Neurology, Veterans Administration Medical Center, Memphis, Tennessee.
Journal of Neurosurgery
|May 1, 1990
Summary
Cheyne-Stokes respiration typically causes rhythmic pupil changes. This case shows a pupil failing to constrict during apnea due to oculomotor nerve compression, resolving after hematoma removal.
Area of Science:
- Neurology
- Ophthalmology
- Respiratory Physiology
Background:
- Cheyne-Stokes respiration (CSR) is characterized by cyclical breathing patterns.
- CSR commonly causes rhythmic pupillary fluctuations synchronized with respiration.
- Pupillary response to hyperpnea and apnea can indicate autonomic nervous system function.
Observation:
- A patient presented with periodic respirations and anisocoria (unequal pupils).
- One pupil failed to constrict during the apnea phase of CSR.
- This suggested a localized neurological deficit affecting pupillary response.
Findings:
- The observed pupillary abnormality was attributed to oculomotor nerve compression.
- Surgical evacuation of a large ipsilateral subdural hematoma was performed.
- Post-operatively, both periodic respirations and anisocoria resolved.
Implications:
- Pupillary response during CSR is a valuable clinical sign.
- Failure of pupillary constriction during apnea may indicate oculomotor nerve compromise.
- Subdural hematoma can present with atypical neurological signs, including pupillary abnormalities.