Wrong side dilated pupil
Neurology recent issues
A 59-year-old man with alcoholic liver disease became comatose from a left acute subdural hematoma. He developed a fixed dilated right pupil but with the left pupil responsive to light. Oculovestibular responses were normal. He had right extensor posturing. At autopsy, uncal herniation was not found, but there was a diagonally shifted and rotated brainstem likely tethering or compressing the contralateral third nerve against the tentorium ridge or clivus (figure). In the pre-CT era, a false localizing fixed pupil led to negative exploratory burr holes. Presently, this phenomenon is still a confusing, inadequately understood curiosity.1,2
Original Article: http://www.neurology.org/cgi/content/short/82/2/187?rss=1
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