Re: Abnormal Pupils and head Pain

Posted By Kevin on April 18, 1999 at 10:22:53
For the last year I have been seeing an optometrist because my
eye pressures were slightly elevated (slight eye pain). Within that year
I have also noticed that my right pupil is sometimes slightly larger
than my left. About 5 weeks ago I woke up one morning and had a
sudden strange headache in the forehead region. Both my pupils appeared
to be quite dilated. My pupils went back to normal after about 15 minutes
and the headache pain turned into a general headache that went away after
I took some tylenol a few hours later. Since then I have had some head
pains that are daily maybe 3-4 times a day. The pain is very local,
sometimes sudden and usually only occur in 3 different spots in my
head. It may go away right away or may hang around for a couple of hours
into the night. To go with these symptoms I usually wake up in the morning
and my right pupil is >2 mm larger than my left (usually if I sleep on my
left side). I may also notice this larger pupil may appear 3 or 4 times
during the day. Usually during the day it is a slight difference but
a few times it has been >2mm. The headaches are typically not debilitating
at all, but I have had a couple of severe sharp bursts (seemed like I
couldn't open my right eye for a second) of pain in a spot
above my right eye. The severe pain lasted only a second and seemed to
be slightly inside my head. This severe pain happened about 5 times in a
2 day span and hasn't happened as severe since. I sometimes get slight
mild quick pain in the same spot. I also sometimes have a slight poping or
snapping sensation within my head. Once I was leaning forward in bed to
drink from a glass. I felt a mild pop in the center of my head and then
had a mild headache.
I have seen my doctor twice and a neurologist twice. I had a CT scan and
the neurologist said the scan was normal. That was the only scan or test
done. He didn't know what to tell me. My doctor said the pain is probably
coming from muscles around my head (tension type headache). I was
wondering if tension type headaches could be so local? He said it was
probably caused by stress. He told me to take alleve twice daily for a
couple weeks. This seems to sometimes mask the symptoms (except for the
temporarily large pupil). I am worried that I might have an aneurysm or
some sort of vascular problem in my head. Do you have any suggestions for
diagnosis or tests that I should have done?
The last symptom that I think I should mention is that sometimes both my
eyes seem to dilate (3mm larger than normal) a couple times a day.  This
is usually accompanied with mild pain in my head.
Thank you for your time in assesing my symptoms.

[CCF Neuro MD*]

Posted By CCF Neuro MD* on April 20, 1999 at 09:50:39
Dear Kevin,
Aniscoria is the medical term for unequal pupils. Some people have abnormal pupils and it is not associated with any other neurological abnormalities.  Of course, there are also sevral reasons for anisocoria that are associated with various conditions.  To differentiate between the various types, it is necessary to evaluate the eyes in general, bright light, dark light, light reactions, and with eye drops (mydratics/miotics).  I cannot differentiate from the info that you gave me.  I recommend discussing this with your neurologist or getting a neuro-ophthamoligist consult. In general, tension headaches tend to be more generalized and producing a bandlike or squeezing sensation. If you are concerend about an aneurysm/vascular malformation an MRI/MRA scan may be helpful but an angiogam is the gold standard. Aneursyms that produce pupil abnormalites usually produce a pupil that is in general mid-dilated and  is fixed to a near light reaction.  It may also produce changes in the nerve branches that innervate the muscles of the eye, subsequently producing weakness and difficulty moving the eye in various directions. If you are interested in getting an evaluation at CCF call 1-800-CCF-CARE.  Good Luck.










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