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Migraine with benign episodic unilateral mydriasis is a nonsurgical cause of anisocoria, with unknown underlying pathophysiology. Unilateral mydriasis has a variety of causes, some of which are life-threatening. The sensitivity of PCT, especially for all severities of disease, distinguishes it from other physiological phenotypes, which may make it useful as a potential biomarker. Additionally, increased PCT correlated with the presence of craniofacial autonomic symptoms, linking pupillary circuit dysfunction to peripheral trigeminal sensitization. We found significantly increased PCT in probable, episodic, and chronic migraine, compared to controls. We used edge-light pupil cycle time (PCT) as a probe of the pupillary light circuit in migraine, paired with clinical assessment of migraine characteristics, and compared these to non-headache controls.
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Though physiological differences exist between migraineurs and non-headache controls, true physiological biomarkers have been elusive, especially for the full clinical spectrum of migraine, inclusive of chronic, episodic, and probable migraine. Diagnosis is currently based on clinical diagnostic criteria.
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Migraine is a neurological disorder characterized by paroxysms of head pain accompanied by trigeminovascular system activation and autonomic dysfunction. Sometimes it is necessary to consider an unusual diagnosis - benign episodic unilateral mydriasis. Strictly taken patient´s history with targeted questions searching for recent contact with some drugs, plants or medications is crucial. Pharmacological diagnostic tests are a very effective method to differentiate between the pharmacological mydriasis and the mydriasis caused by another factor. Diagnostic challenge is well- described with the analysis of important Pilocarpin pharmacological tests. In both of the cases the anisocoria is temporary with spontaneous resolution without any therapy. Causes of an unequal size of the eyes' pupils are in this two cases different. In the article authors present the issue of the anisocoria in the childhood through two case presentations. Understanding to the anatomical, physiological and pharmacological influences helps us to solve the diagnostic challenge. The most important point is the ability to find the anatomical location of the pathology. There is a broad spectrum of aetiological factors including benign and also life- threatening situations. Anisocoria is a condition characterized by an unequal size of the eyes' pupils.