IMAGES IN CLINICAL MEDICINE

Migraine with unilateral mydriasis

JOSEPH H. FRIEDMAN, MD

38 40 EN A 54-year-old, post-menopausal woman has had migraine head- aches since the age of 40, occur- ring about once per month, responding well to sumatriptan. She experiences a stabbing pain in the left eye and left side of head, associated with nausea and vom- iting. The pain has only affected her left side but a brain MRI was normal. She has an aura of blurred vision in the left eye alone, see- ing images as if through a broken glass, with shimmering lights but no scotoma. She experienced a headache at work and a resolution limit the diagnosis to a benign process. co-worker noticed her left pupil to be markedly dilated (see Probably the most common cause for episodic unilateral photo). Her medical history was otherwise unremarkable. mydriasis is due to handing a scopolamine patch then touching She does not know if she’d had a dilated pupil previously. one eye. Her neurological and funduscopic exam, after the episode resolved, were normal. She takes thyroid supplement as her Author only medication. Joseph H. Friedman, MD is Editor-in-chief of the Rhode Island Medical Journal, Professor and the Chief of the Division of Benign episodic unilateral mydriasis (1) is due either to sym- Movement Disorders, Department of Neurology at the Alpert pathetic overactivity, causing increased dilatation, or para- Medical School of Brown University, chief of Butler Hospital’s sympathetic underactivity, causing decreased contraction. Movement Disorders Program and first recipient of the Stanley No other third-nerve symptoms had been present (ptosis or Aronson Chair in Neurodegenerative Disorders eye movement limitations that would cause diplopia). The References association with recurrent migraines, previous normal brain 1. Skeik N, Jabr FI. Migraine with benign episodic unilateral MRI, absence of other neurological symptoms and complete mydriasis. Int J Gen Med 2011;4:501-3.

Submission information for Images/Videos in Clinical Medicine section Original, high-resolution images and videos, which have not been published elsewhere, will be considered. In a separate Word document please include a brief title, and legend (150 words or less) provid- ing relevant clinical information, findings, clinical course, and response to treatment if initiated. Any information that might identify the patient or hospital, including the date, should be removed from the image unless a patient release is obtained by the physician. Please include authors’ names (limited to two authors), academic positions, address, e-mail address and telephone number. Submissions should be sent to Dr. Joseph H. Friedman, editor-in-chief, at [email protected] and Mary Korr, managing editor, at [email protected].

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