{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T16:55:27Z","timestamp":1778000127053,"version":"3.51.4"},"reference-count":15,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2020,12,21]],"date-time":"2020-12-21T00:00:00Z","timestamp":1608508800000},"content-version":"unspecified","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,11,30]]},"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:p>There are several causes for sudden onset unilateral mydriasis, however impending transtentorial uncal herniation needs to be ruled out. This unique case highlights an uncommon adverse response to a common mode of treatment that leads to a diagnostic dilemma. A 3-year-old boy with a ventriculoperitoneal (VP) shunt for an obstructive hydrocephalus presented with an acute respiratory distress. He developed unilateral mydriasis with absent light reflex during treatment with nebulisers. An urgent CT scan of the brain did not show any new intracranial abnormality. A case of pharmacological anisocoria was diagnosed that resolved completely within 24 hours of discontinuation of ipratropium bromide. Although ipratropium-induced anisocoria has been reported in children, but to our knowledge none in a child with VP shunt for hydrocephalus. This emphasises the urgency in evaluating unilateral mydriasis to rule out life-threatening conditions. Clinicians should remember that ipratropium administered through ill-fitting face masks could cause this completely reversible adverse effect.<\/jats:p>","DOI":"10.1136\/bcr-2020-237257","type":"journal-article","created":{"date-parts":[[2020,12,22]],"date-time":"2020-12-22T18:18:21Z","timestamp":1608661101000},"page":"e237257","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Unilateral mydriasis in a child with a ventriculoperitoneal shunt for obstructive hydrocephalus: a diagnostic dilemma"],"prefix":"10.1136","volume":"13","author":[{"given":"Monidipa","family":"Banerjee","sequence":"first","affiliation":[{"name":"Department of Paediatrics, Ysbyty Gwynedd, Bangor, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eiman","family":"Haj Ahmed","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Ysbyty Gwynedd, Bangor, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathryn","family":"Foster","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Ysbyty Gwynedd, Bangor, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8878-9170","authenticated-orcid":false,"given":"Arundoss","family":"Gangadharan","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Ysbyty Gwynedd, Bangor, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,12,22]]},"reference":[{"key":"2025082804304395000_13.12.e237257.1","first-page":"832","article-title":"\"Simple central\" anisocoria: a common condition, seldom recognized","volume":"83","author":"Loewenfeld","year":"1977","journal-title":"Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol"},{"key":"2025082804304395000_13.12.e237257.2","first-page":"14796","article-title":"Case Report - Nebulized ipratropium bromide in fixed dilated pupil: three cases report and review of literature","volume":"9","author":"Liu","year":"2016","journal-title":"Int J Clin Exp Med"},{"key":"2025082804304395000_13.12.e237257.3","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9394(87)90296-0"},{"key":"2025082804304395000_13.12.e237257.4","doi-asserted-by":"crossref","first-page":"622","DOI":"10.3928\/00904481-20091016-07","article-title":"Acute pupil asymmetry in a 6-Month-Old boy. diagnosis: pharmacologic anisocoria","volume":"38","author":"Osorio","year":"2009","journal-title":"Pediatr Ann"},{"key":"2025082804304395000_13.12.e237257.5","doi-asserted-by":"publisher","DOI":"10.1136\/bcr.08.2011.4697"},{"key":"2025082804304395000_13.12.e237257.6","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0420.2002.800319.x"},{"key":"2025082804304395000_13.12.e237257.7","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1974.00490370038003"},{"key":"2025082804304395000_13.12.e237257.8","doi-asserted-by":"crossref","first-page":"501","DOI":"10.2147\/IJGM.S18613","article-title":"Migraine with benign episodic unilateral mydriasis","volume":"4","author":"Skeik","year":"2011","journal-title":"Int J Gen Med"},{"key":"2025082804304395000_13.12.e237257.9","unstructured":"Kadar S , Biousse V , Newman NJ . Approach total patient with anisocoria. Available: https:\/\/www.uptodate.com\/contents\/approach-tothe-patient-with-anisocoria [Accessed 27 May 2020]."},{"key":"2025082804304395000_13.12.e237257.10","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1016\/j.jocn.2006.07.020","article-title":"Pharmacological mydriasis secondary to ipratropium bromide: a cause of unilateral dilated pupil","volume":"15","author":"Sharma","year":"2008","journal-title":"J Clin Neurosci"},{"key":"2025082804304395000_13.12.e237257.11","first-page":"268","article-title":"Nebulised ipratropium causing a unilateral fixed dilated pupil in the critically ill patient: a report of two cases","volume":"6","author":"Eustace","year":"2004","journal-title":"Crit Care Resusc"},{"key":"2025082804304395000_13.12.e237257.12","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1007\/s12024-020-00309-1","article-title":"Fatal ventriculoperitoneal shunt occlusions diagnosed at autopsy","volume":"16","author":"White","year":"2020","journal-title":"Forensic Sci Med Pathol"},{"key":"2025082804304395000_13.12.e237257.13","unstructured":"Decker R , Pearson-Shaver AL . Uncal Herniation. In: StatPearls. Treasure Island (FL: StatPearls Publishing, 2020."},{"key":"2025082804304395000_13.12.e237257.14","first-page":"89","article-title":"Is it possible to recover from uncal herniation? analysis of 71 head injured cases","volume":"42","author":"Uzan","year":"1998","journal-title":"J Neurosurg Sci"},{"key":"2025082804304395000_13.12.e237257.15","doi-asserted-by":"crossref","first-page":"1217.e3","DOI":"10.1016\/j.ajem.2019.03.047","article-title":"Pharmacologic anisocoria due to nebulized ipratropium bromide: a diagnostic challenge","volume":"37","author":"Kokulu","year":"2019","journal-title":"Am J Emerg Med"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-237257","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T11:30:55Z","timestamp":1756380655000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-237257"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12]]},"references-count":15,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2020,12,22]]},"published-print":{"date-parts":[[2020,12]]}},"alternative-id":["10.1136\/bcr-2020-237257"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-237257","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12]]}}}