Localizing Thalamomesencephalic Afferent and Efferent Pupillary Defects

Ardalan Sharifi, Rohini R. Sigireddi, Lance J. Lyons, Ashwini T. Kini, Bayan A. Al Othman, Andrew G. Lee

Research output: Contribution to journalArticlepeer-review


A 42-year-old Algerian man presented for binocular oblique diplopia, hypersomnolence with drop attacks, bilateral hearing loss, and thoracic pain. He had a right thalamomesencephalic hemorrhage due to an underlying cavernous malformation treated with subtotal surgical resection. On neuro-ophthalmic examination, the patient had a left relative afferent pupillary defect and a right oculosympathetic efferent pupillary defect (i.e., Horner syndrome) in addition to other thalamomesencephalic eye and neurologic signs (right fourth nerve palsy, hearing loss, hemiparesis, and thalamic pain). Clinicians should recognize the localizing value of this unique constellation of mesencephalic afferent and efferent pupillary defects.

Original languageEnglish (US)
Pages (from-to)E136-E138
JournalJournal of Neuro-Ophthalmology
Issue number1
StatePublished - Mar 1 2021

ASJC Scopus subject areas

  • Ophthalmology
  • Clinical Neurology


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