3 YO Boy With Meningoencephalitis Presenting with Afferent Pupillary Defect (Right Side) and a Sluggish Reacting Pupil on the Left
January 14, 2011
What would you suspect in 3 year old boy with three days history of meningoencephalitis presenting with unilateral total afferent pupillary defect (right sided) and a sluggish reacting pupil on the left?
Patient is unconscious and not responding to any stimuli.
Other manoueuvres cannot be elicited.
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‘total afferent defect” is not the standard way of description. a relative afferent pupillary defect is where the pupil reacts less briskly compared to the other eye due to optic nerve pathway problem, and is always relative (if both eyes are equally affected, there is no relative afferent pupillary defect.). by swinging a light from one eye to the other, the good eye causes both pupils to constrict, and so when the light is swung to the bad eye, one will see some dilation. the degree of this dilation depends on the severity of the optic nerve disease.
it sounds like you mean the the right pupil is dilated and non-reactive at all to light, and the other pupil is sluggishly reactive. this sounds like bilateral cn iii palsy due to meningitis. an mri of course is indicated here. a bilateral p-comm aneurysm (very rare) is also possible. i need to know the eom’s and other c n function in order to better localize the problem.