Tadpole pupil
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A young woman has recurrent episodes of unilateral mydriasis lasting several minutes. The left pupil becomes large and deformed, described as “egg-shaped” (figure). Examination, including pharmacologic pupil tests, revealed no ophthalmologic or neurologic abnormalities. Cranio-orbital MRI was normal. Diagnosis of tadpole pupil was confirmed by self-taken photographs using a cellular phone.
(Top) On examination, the pupils are round, isocoric, and reactive to light. (Bottom) On this self-taken photograph, the left pupil is no longer round and is larger than the right pupil. Focal dilation of the superonasal sector of the left pupil is readily visible.
Spontaneous segmental spasm of the iris dilator can cause pupillary distortion that resembles the shape of a tadpole.1,2 Occasional patients with tadpole pupil have underlying Horner syndrome; otherwise, the syndrome is benign and self-limited.1 Cellular phone “telemedecine” was particularly helpful in diagnosing this form of episodic mydriasis.
Footnotes
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A. Kawasaki has received honoraria from serving on a scientific advisory panel for Bayer SpA. C. Mayer reports no disclosures. Go to Neurology.org for full disclosures.
- Copyright © 2012 by AAN Enterprises, Inc.
References
Letters: Rapid online correspondence
- Reply to Dr. Friedman
- Aki Kawasaki, Lausanne, Switzerland, xAki.Kawasaki@fa2.ch
- x
Submitted April 08, 2013 - Episodic Tadpole Pupil - Possibly a Migraine Variant?
- Deborah I. Friedman, Professor, University of Texas Southwestern Medical CenterDeborah.Friedman@utsouthwestern.edu
- Deborah I. Friedman, Dallas, TX
Submitted April 02, 2013 - Tadpole pupil
- Robert A. Egan, St. Helena Hospitaleganr8@gmail.com
- Napa, CA
Submitted October 09, 2012 - Response to comment by Dr. Egan
- Aki Kawasaki, faculty, H?pital Ophtalmique Jules Goninaki.kawasaki@fa2.ch
- Aki Kawasaki , Lausanne, Switzerland
Submitted October 09, 2012
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