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VOLUME 18 , ISSUE 3 ( March, 2014 ) > List of Articles

CASE REPORT

Unilateral pupillary mydriasis from nebulized ipratropium bromide: A false sign of brain herniation in the intensive care unit

Priyanka Chaudhry, Deborah I. Friedman, Wengui Yu

Keywords : Anisocoria, hemiparesis, ipratropium bromide, mydriasis, uncal herniation

Citation Information : Chaudhry P, Friedman DI, Yu W. Unilateral pupillary mydriasis from nebulized ipratropium bromide: A false sign of brain herniation in the intensive care unit. Indian J Crit Care Med 2014; 18 (3):176-177.

DOI: 10.4103/0972-5229.128710

License: CC BY-ND 3.0

Published Online: 00-03-2014

Copyright Statement:  Copyright © 2014; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Although there are many causes of anisocoria in the intensive care setting, the development of unilateral mydriasis in patients with intracranial hemorrhage or tumor is a neurological emergency, as it may herald the onset of uncal herniation. We describe two patients with a hemiparesis from neurosurgical disorder who subsequently developed a fixed and dilated pupil. The pupillary abnormality was caused by nebulized ipratropium bromide in both cases, and resolved when the medication was discontinued. Nebulized ipratropium may leak from the mask into ipsilateral eye and cause mydriasis in patients with facial weakness. This benign cause of anisocoria in the intensive care setting is distinguished from uncal herniation by the laterality of neurologic findings, and lack of mental status change, ptosis, and extraocular movement impairment.


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  1. Helprin GA, Clarke GM. Unilateral fixed dilated pupil associated with nebulised ipatropium bromide. Lancet 1986;2:1469.
  2. Goldstein JB, Biousse V, Newman NJ. Unilateral pharmacologic mydriasis in a patient with respiratory compromise. Arch Ophthalmol 1997;115:806.
  3. Openshaw H. Unilateral mydriasis from ipratropium in transplant patients. Neurology 2006;67:914.
  4. Bisquerra RA, Botz GH, Nates JL. Ipratropium-bromide-induced acute anisocoria in the intensive care setting due to ill-fitting face masks. Respir Care 2005;50:1662-4.
  5. Sharma NS, Ooi JL, Papalkar D, Sharma S, Francis IC, Fung VS. Pharmacological mydriasis secondary to ipatropium bromide: A cause of unilateral dilated pupil. J Clin Neurosci 2008;15:320-1.
  6. Krovvidi HP, Thillaivasan A. A benign cause for a unilateral dilated pupil in a critical care patient. Eur J Anaesthiol 2008;25:692-3
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