# You ever seen this...



## ffemt8978 (Nov 7, 2004)

Recently responded to 18yoM who was playing football and when he went up for a pass was hit and landed on his head or back, depending upon who you talk to.  Pt. gets up and walks off the field, and tells his coach that he was faking it.  Approximately 15 minutes later, we're paged out because he has reportedly gone unconscious.

Upon our arrival, Pt. is CAO to Person and Events, but disorientated to Time and Place.  He was also very lethargic and slurring his speech.  Pt. C/O Neck tingling and paralysis in his left leg (pulses and sensation still present).  We board and collar him, and I go to do a pupil check.  Rt pupil is reactive to light, but the left pupil dilates (yes, dilates) when light is applied.

Assessement: Closed head injury with neuromuscular impairment.

We load him up and begin a transport to an ALS intercept.  During the transport, Pt. condition improves to the point that he is CAOx4, GCS=15, tingling in his neck is gone, and he has regained movement in his left leg.  Even his pupils are now PERL.  (Made me look like an idiot to the paramedic, who was having a hard time believing my report of his condition on scene.)

Anyway, has anyone ever heard of a head injury causing a pupil to dilate to light?  I haven't, and I must say it freaked me out.  BTW, 2 other EMT's on scene also observed the pupils and saw the same thing I did.


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## MMiz (Nov 7, 2004)

Once again an amazing story.  I did some googling, and found this:

http://www.medhelp.org/forums/neuro/archive/13264.html


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> Transient and intermittent pupillary dilatation after a concussion without any other neurological signs or alteration of consciousness is likely due to mild injury to a portion of the 3rd cranial nerve. Part of the 3rd cranial nerve controls the parasympathetic input to the pupil which, in its absence, can cause pupillary dilation. This usually resolves with time. If the pupillary dilatation were associated with alterations in consciousness, eye deviation and weakness on the opposite side of the body, a more serious situation would be developing. If you see any of these signs you should seek help immediately.
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Many sites had a version of the following:
http://www.thrombosis-consult.com/articles...xillofacial.htm


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> Swing the penlight back and forth between the pupils, and if a pupil dilates when initially struck by light, an optic nerve or retinal injury is likely.
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Interesting though, I'll still ask around!


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