Internal and external dysfunction | Risk of aneurysm | Recommendation |
Complete internal dysfunction ("pupil blown") | ||
With complete external dysfunction | Highest | MRI/MRA (CTA) catheter angiogram |
With incomplete external dysfunction | Highest | MRI/MRA (CTA) catheter angiogram |
Without external dysfunction | Minimal | No imaging |
Incomplete internal dysfunction ("partial pupil") | ||
With complete external dysfunction | Uncertain, probably low | MRI/MRA (CTA) consider catheter angiogram |
With incomplete external dysfunction | Uncertain, minimal | MRI/MRA (CTA) consider catheter angiogram |
Without external dysfunction | Minimal | No imaging |
No internal dysfunction ("pupil not involved") | ||
With complete external dysfunction | Low if isolated | Observe |
With incomplete external dysfunction | Uncertain | MRI/MRA (CTA) consider catheter angiogram |
Internal dysfunction refers to the ability of the pupil to constrict. Complete internal dysfunction produces a large, unreactive pupil.
External dysfunction refers to extraocular motor function including the eyelid. Eyes with complete external dysfunction have prominent ptosis as well as paralysis of adduction, elevation, and depression.
Isolated refers to the absence of other neurologic signs or symptoms.
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