Unilateral pupillary dilatation during focal seizures

Abstract

Pupillary dilatation was observed in a young boy who had a sudden onset of right focal seizures. Clinical and laboratory investigation revealed the presence of a benign left frontal epileptic focus. Lacking signs of third cranial nerve compression, this transient pupillary abnormality could be caused by the contralateral frontal epileptic focus. Such a focus might inhibit dilatation of the homolateral pupil, thus permitting dilatation of the contralateral pupil only. Unilateral mydriasis as described hereby could also represent a pupillary "Todd's Paralysis" caused by the contralateral frontal epileptic focus.

Unilateral fixed mydriasis: an uncommon presentation of temporal lobe epilepsy

“…The coexistence of other sympathetic phenomena (excessive sweating, flushing) suggests the activation of areas of the central autonomic network [6]. Our patient is in keeping with previous observations of mydriasis ipsilateral to temporal epilepsy [5,6], while mydriasis was contralateral to frontal foci [3]. Whether mydriasis is caused by epileptic discharges or represents postictal Todd's paralysis is still unclear [4].…”

“…Fixed mydriasis has been very seldom reported in epilepsy [3][4][5][6]. The coexistence of other sympathetic phenomena (excessive sweating, flushing) suggests the activation of areas of the central autonomic network [6].…”

Epilepsy causing pupillary hippus: an unusual semiology

“…Bilateral or unilateral pupillary changes have been repeatedly reported in seizures, especially dilation (Klein & Early, 1948; Muller‐Jensen & Hagenah, 1978; Gadoth et al., 1981; Loewenfeld, 1999). Pupillary dilation accompanying epileptic seizures is brought about by a superimposition of both sympathetic excitation and parasympathetic inhibition, as proven by pharmacologic testing (Klein & Early, 1948).…”

Epilepsie und autonome Störungen

“…Als Ausdruck der diffusen Aktivierung des sympathischen Nervensystems wird bei generalisierten Anfällen eine bilaterale Mydriasis beobachtet. Einseitige Mydriasis kann bei ipsilateralen wie auch kontralateralen Anfallsherden gesehen werden [53,131,189].…”