![]() We call for more research to understand fully the underlying pathophysiology which would help in managing this condition.Anisocoria means the presence of difference in the size of the right and left pupils. Here we report a rare case of BEUM diagnosed in a young lady with a history of migraine, supporting the association between the two conditions. According to one case series report, patients with isolated benign episodic mydriasis appear to have a benign neurological prognosis, and do not require further neurodiagnostic studies. Management and prognosis are determined by the underlying etiology. 4, 8Ī detailed medical history, including active medications, full physical examination, including a careful ophthalmic and neurological system evaluation, and if indicated, imaging studies, should be performed to rule out other possible underlying conditions that sometimes can be life-threatening. 8, 9 Furthermore, a family history of migraine or headache was reported in patients with BEUM. BEUM was also reported in migraine without aura or ophthalmoplegia, suggesting that it is a concomitant symptom. 7Īccording to one report of seven patients with BEUM associated with migraine, four had classic, one had common, and one had post-traumatic migraine. ![]() 6 Other possible mechanisms include ischemia or oculomotor nerve demyelination caused by neuropeptides secreted at the level of circle of Willis upon the activation of the trigeminovascular system causing edema and inflammation. 3 The occurrence of mydriasis in ophthalmoplegic migraine can be due to functional exhaustion of parasympathetic fibers running within the IIIrd cranial nerve. However, some cases have been described with no accompanying headache. 3, 5 It can occasionally accompany migraine and some authors classify it as a limited form of ophthalmoplegic migraine. 4 The underlying physiopathology is not always clear and may involve either parasympathetic deficiency or sympathetic hyperactivity affecting the iris. 3 The episodes may be accompanied by blurred vision, orbital pain, headache, or photosensitivity. 1, 2īenign episodic unilateral mydriasis is an isolated benign cause of pupil asymmetry. Other causes include medications, infection, aneurysm, IIIrd nerve palsy, closed-angle glaucoma, and trauma. She had normal cerebrospinal fluid analyses, head and neck magnetic resonance imaging and angiography, cervical, thoracic, and lumbar magnetic resonance imaging, electroencephalography, and electromyography of the lower extremities.Ĭauses of pupil asymmetry (anisocoria) range in seriousness from a normal, physiological condition (seen in 20% of normal people) to one that is immediately life-threatening, as seen with major stroke or intracranial bleed. Her complete blood count, metabolic profile, and thyroid function test were unremarkable. The rest of the neurological and physical examination was unremarkable. Physical examination revealed a fixed dilated right pupil ( Figure 1), decreased proximal and distal muscular strength (3/5) in the lower extremities with normal reflexes. There was no family history of similar eye disturbance. She denied using illicit drugs, herbal, or other medications, including ones over the counter. Her medications at presentation were duloxetine HCl 60 mg daily, trazodone HCl 100 mg at night, gabapentin 900 mg three times a day, and clonazepam 0.5 mg twice a day as needed. Her past medical history was important for obesity, tobacco use, fibromyalgia, and depression. She denied any recent head trauma, fever, chills, or other complaints. Severe episodes were sometimes associated with transient right eye mydriasis ( Figure 1), significant lower extremity weakness and at times confusion that all resolved with the resolution of her migraine episode. A 30-year-old lady with a history of migraine headache presented with a one-year history of chronic intermittent, bilateral, throbbing, and at times very severe, headache that often lasted for days and was associated with blurry vision, nausea, vomiting, photophobia, and phonophobia.
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