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Can concussion cause asymmetric pupillary size?

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Posted on Tue, 10 May 2016
Question: rear ended car accident . i have post concussion syndrome. one pupil is slightly smaller than the other but both respond the same to light. coratid artery ultrasound and head CT scans normal. can a concussion cause the difference in pupil size.
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Answered by Dr. Dariush Saghafi (35 minutes later)
Brief Answer:
Concussion can cause asymmetric pupillary sizes

Detailed Answer:
Good morning. Thank you for considering this network to ask your question.

The direct answer to the question of whether or not TBI can cause a pupil to have a different size compared to the other is a definite YES....that is possible, however, I believe that after what you've presented by way of history what should be ruled out sooner rather than later is something referred to as a carotid artery dissection which would be posttraumatic in nature...in another words the act of the collision and striking the head can cause pupillary asymmetry but the more immediate danger is that there could be a carotid artery DISSECTION which can lead to strokes to critical parts of the brain and cause either significant strokes and weakness requiring months of rehabilitation...or worse yet....patients have been known to die from these types of things so getting it assessed right away is job 1 in my opinion. What is the actual measurement difference between 1 side and the other according to whoever checked your eyes and found the pupillary asymmetry.

If I were your neurologist I would be ordering (if not already done) MRI of the brain and MRA of the head and neck. I would also order those studies with gadolinium contrast. You will probably also need a standard angiogram if anything suspicious were to show up on the scans.

I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues. Feel free to upload images if you'd like.

Otherwise, I'd appreciate your rating this interaction with a HIGH STAR SCORE and look forward to a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY if you're satisfied with my response.

Write to me any time at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if you'd like which I would love to receive from you to see just what has been discovered.

Many thanks for using this service to ask your questions. Be well.

This consult request has taken a total of 15 minutes of time to read, research, and respond
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Dariush Saghafi (43 minutes later)
I had 2 head CT scans and a coratid artery ultrasound all were normal. no tears, disections, or blockages. so could time be the cure and concussion be the cause.
doctor
Answered by Dr. Dariush Saghafi (5 hours later)
Brief Answer:
So glad to hear tests were negative

Detailed Answer:
If dissection has been ruled out on the basis of testing then the asymmetry in your pupils can definitely a function of the concussion itself and if the pupillary control fibers were "stunned" temporarily by this force to the head then, it is possible that "tincture of time" will be the cure. Also, keep in mind that not everyone's pupils are matched exactly in size anyways just due to normal asymmetric patterns we see all the time from part of the body to another. You haven't really stated exactly how many mm. the size difference is from one pupil to the other. Clearly, if it is obvious there is now a difference where one never existed then, the concussion can be to blame. However, if the difference were 1 mm. or less it is also possible that you'd always had this at baseline and not until the concussion was it ever really noticed. Even routine ocular exams in normal people do not necessarily result in these sorts of minute differences being picked up by the optometrist since the patient's not complaining of anything.

But in any event the most important thing is that your pupillary size difference (whatever it may be) has nothing to do with obvious pathology that could cause grave consequences if not treated. That is very good news.

I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues. Feel free to upload images if you'd like.

Otherwise, I'd appreciate your rating this interaction with a HIGH STAR SCORE and look forward to a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY if you're satisfied with my response.

Write to me any time at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if you'd like which I would love to receive from you to see just what has been discovered.

Many thanks for using this service to ask your questions. Be well.

This consult request has taken a total of 50 minutes of time to read, research, and respond
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 2473 Questions

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Can concussion cause asymmetric pupillary size?

Brief Answer: Concussion can cause asymmetric pupillary sizes Detailed Answer: Good morning. Thank you for considering this network to ask your question. The direct answer to the question of whether or not TBI can cause a pupil to have a different size compared to the other is a definite YES....that is possible, however, I believe that after what you've presented by way of history what should be ruled out sooner rather than later is something referred to as a carotid artery dissection which would be posttraumatic in nature...in another words the act of the collision and striking the head can cause pupillary asymmetry but the more immediate danger is that there could be a carotid artery DISSECTION which can lead to strokes to critical parts of the brain and cause either significant strokes and weakness requiring months of rehabilitation...or worse yet....patients have been known to die from these types of things so getting it assessed right away is job 1 in my opinion. What is the actual measurement difference between 1 side and the other according to whoever checked your eyes and found the pupillary asymmetry. If I were your neurologist I would be ordering (if not already done) MRI of the brain and MRA of the head and neck. I would also order those studies with gadolinium contrast. You will probably also need a standard angiogram if anything suspicious were to show up on the scans. I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues. Feel free to upload images if you'd like. Otherwise, I'd appreciate your rating this interaction with a HIGH STAR SCORE and look forward to a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY if you're satisfied with my response. Write to me any time at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if you'd like which I would love to receive from you to see just what has been discovered. Many thanks for using this service to ask your questions. Be well. This consult request has taken a total of 15 minutes of time to read, research, and respond