Cerebral Concussion vs. Shunt Dysfunction
Left picture: In this case a cerebral concussion has occurred. Right picture: The diagnosis is an advanced stage of shunt dysfunction with an uncal herniation on the right side. Left picture: The anisocoria has nothing to do with the head injury and is not the sequel of an administered mydriatic on the involved side. It is a pupillary anomaly having existed since birth. Nevertheless, transient pupillary anomalies may occur in atypical cerebral concussion (delayed encephalopathy).
Both girls have an anisocoria, in which the right pupil is wider than the left, and had a clouding of consciousness. Left picture: In this case a head injury is known. Right picture: No statements about a trauma to the head were made about this girl. Left picture: This patient is interested and has no other eye signs at the moment the photograph was taken. Right picture: On raising the eyelids the girl has a void look, and the right bulbus remains in a position of abduction.