Seeking Insights on New Onset Anisocoria
A 37-year-old female, 5'8" and weighing 168 pounds, is presenting with new onset anisocoria that has been noticeable for approximately a month. She is a non-smoker and does not consume drugs or alcohol. For the past three years, she has been prescribed typical medications for Postural Orthostatic Tachycardia Syndrome (POTS), including propranolol, midodrine, and Atomoxetine, which she takes to address severe fatigue. Her treatment is managed at the Vanderbilt Autonomic Dysfunction Center located in Nashville, Tennessee, USA. Her medical background includes idiopathic POTS, neurocardiogenic syncope, and migraines without aura. She initially began experiencing right-sided migraines in 2018, which have continued since then. An MRI conducted in 2018 returned normal results; however, a follow-up MRI in April 2025 did reveal one white matter lesion in the frontal lobe. In addition to her headaches, she has experienced left-sided facial numbness, tingling, and cold sensations. Recently, she reported new numbness in her left hand, forearm, and foot accompanied by tingling. Vision changes occurred over the past year, leading to an MRI in April that revealed these issues as blurred and occasional double vision. While the right-sided migraine tends to fluctuate, it is generally persistent, and she occasionally suffers from right-sided vertigo. The anisocoria, characterized by a dilation of the right pupil, began about a month ago, but an eye examination returned normal findings. She is seeking advice from neuro specialists regarding her symptoms and potential implications.
Answers (1)
9/10/2025, 10:20:39 PM
OpenHealth AI
It's understandable to feel concerned about the onset of anisocoria (unequal pupil sizes) along with your other neurological symptoms. Given your medical history, particularly with POTS and the white matter lesion, it's important to closely monitor your symptoms and work with specialists.
Explanation:
Anisocoria can have various causes, including neurological conditions, inflammation, or medication side effects. In your case, with the background of migraines, facial numbness, and new neurological symptoms, it's crucial to consider potential underlying causes, such as a neurological condition that may require further investigation.
Next Steps:
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Symptom Monitoring: Keep a diary of your symptoms, noting any changes in the severity or nature of the anisocoria, facial numbness, and any new sensations in your extremities. Record when these symptoms occur, how long they last, and any potential triggers (e.g., stress, fatigue).
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Follow-Up with Specialists: Since you are already in contact with neuro specialists, ensure that you convey your recent symptoms, including the anisocoria and new numbness in your left hand, forearm, and foot. Consider requesting a comprehensive evaluation to determine if further imaging or tests are necessary.
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Medication Review: Discuss your current medications with your healthcare provider to assess if any could be contributing to your symptoms. Propranolol, midodrine, and Atomoxetine can have side effects that might be relevant.
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Visual Symptoms: Given your complaints of blurred and double vision, it may be helpful to undergo a detailed eye exam if you haven't recently, or consult with a neuro-ophthalmologist who specializes in visual disruptions linked to neurological issues.
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Stay Hydrated and Manage Symptoms: Ensure adequate hydration and get sufficient rest, as fatigue can worsen POTS symptoms. Use strategies that help manage your migraines, and practice relaxation techniques to reduce stress.
Your symptoms warrant compassionate and thorough evaluation, and continuing close communication with your healthcare team is essential. Please feel free to reach out if you have further questions or need more detailed information on any aspect.
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