Transient anisocoria after a traumatic cervical spinal cord injury: A case report

Spinal cord injuries can disrupt the autonomic nervous system, leading to complications such as anisocoria, a condition characterized by unequal pupil sizes. Understanding autonomic pathways is crucial for diagnosing and treating these complications. Autonomic dysreflexia, a life-threatening condition, can occur in individuals with spinal cord injuries above T6, leading to elevated blood pressure and other symptoms. Recognizing less common signs, like pupillary changes, is important for timely diagnosis and treatment. This case report describes a patient with a C4-C6 spinal cord injury who experienced transient anisocoria, highlighting the importance of understanding the sympathetic supply to the pupil and how changes may occur with alterations in sympathetic outflow.

• 1
  A patient with an incomplete C4 spinal cord injury experienced two isolated events of anisocoria (unequal pupil sizes) during inpatient rehabilitation.
• 2
  The anisocoria occurred with minimal to no elevation in blood pressure, suggesting it may be a form of dysautonomia distinct from typical autonomic dysreflexia.
• 3
  Adjustments to a cervical-thoracic orthotic during one event led to improvement in pain and resolution of the anisocoria, indicating a potential link between noxious stimuli and sympathetic response.