Korean J Crit Care Med.  2015 Aug;30(3):191-195. 10.4266/kjccm.2015.30.3.191.

Fixed Pupillary Light Reflex due to Peripheral Neuropathy after Liver Transplantation

• Kim KH
• Kim N
• Na S
• Jang J
• Kim J

• KMID: 2227648
• DOI: http://doi.org/10.4266/kjccm.2015.30.3.191

Abstract

A 46-year-old female patient was admitted to the intensive care unit (ICU) after liver transplantation. About an hour later after the ICU admission, she had no pupillary light reflex. Both pupils were also fixed at 5 mm. Patients who undergo liver transplantation are susceptible to neurologic disorders including hepatic encephalopathy, thromboembolism and intracranial hemorrhage. Abnormal pupillary light reflex usually indicates a serious neurologic emergency in these patients; however, benign neurologic disorders such as peripheral autonomic neuropathy or Holmes-Adie syndrome should also be considered. We experienced a case of fixed pupillary light reflex after liver transplantation diagnosed as peripheral autonomic neuropathy.

Keyword

Adie syndrome; liver transplantation; peripheral nervous system diseases; reflex, pupillary

MeSH Terms

Adie Syndrome
Emergencies
Female
Hepatic Encephalopathy
Humans
Intensive Care Units
Intracranial Hemorrhages
Liver Transplantation*
Liver*
Middle Aged
Nervous System Diseases
Peripheral Nervous System Diseases*
Pupil
Reflex*
Reflex, Pupillary
Thromboembolism

Figure

• 

  Fig. 1. Brain computed tomography. One month before intensive care unit (ICU) admission, a multifocal contusional intracranial and subarachnoid hemorrhage was observed in the left cerebral hemisphere after a fall. Combined peri-lesional edema was observed in the left temporal lobe (A). Decreased density of the previously noted trauma-associated hemorrhage was observed after ICU admission. Mild edematous change and isodense hematoma remain in the left cerebral hemisphere without hydrocephalus (B).

• 

  Fig. 2. Pilocarpine instillation test. Both eyes show a 5-mm fixed pupil diameter when stimulated with light (A). After 0.125% pilocarpine instillation, there is no response in both eyes (B). After 1% pilocarpine instillation, both eyes constrict from 5 mm to 3 mm (C).

Reference

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