Anisocoria is pupil’s asymmetrical reaction to light. The etiology behind anisocoria is mostly due to disorders affecting the sympathetic and parasympathetic pathways. Possible etiologies for unilateral midriasis include parasympathetic denervation (CN III palsy), Adie’s tonic pupil, traumatic and pharmacological mydriasis and acute glocoma crises. The most common etiology that leads to unilateral miosis include sympathetic denervation (Horner syndrome), pharmacological miosis and iridocyclitis. It may not always be easy to evaluate anisocoria or the abnormal pupil. A careful neuro-ophthalmological exam and differential diagnosis is warranted in patients who present with anisocoria. In this article, we would like to present a patient with migraine headache and episodic anisocoria and further discuss the possible pathophysiology of this presentation.
Key words: Headache, migraine, anisocoria, mydriasis, miosis
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