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  #1  
Old 03-04-2011, 07:02 PM
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Seizures and Pinpoint Pupils? Pupil Size?


Back on February 3, 2011, I had my second seizure since ending up in a ditch back in December. What was interesting about this particular seizure though was that I happened to be OCD-cleaning something (I have OCD, too) and standing in front of the bathroom mirror at the seizure's onset.

At the very first sign of this seizure (a funny taste in my mouth), I happened to be 'conscious' enough to briefly glance at my face in the mirror and noticed that for a fraction of a second (literally...less than a second) my pupils grew larger, but then they quickly reverted back to their 'normal' pinpoint size as the dizziness/confusion part of my seizure began.

My question...

I keep mentioning my pinpoint pupils to doctor after doctor, even the neurologist who is currently evaluating me for these seizures, and though my pupils react somewhat to light (barely), I do not believe their size is truly 'normal' by any means. By that I mean that they don't respond to DARKNESS by enlarging, which is perhaps why even neuros don't understand why I'm so concerned and frustrated. Whether I am standing in the sun or sitting in the dark, my pupils are ALWAYS tiny, and neuros have only ever checked to see if shining a light in my eyes causes my pupils to get any tinier. They DON'T check to see if they enlarge in darkness.

How large should my pupils be in a darkened room? I couldn't even drive at night anymore even if this seizure stuff was behind me because of how tiny my pupils are day and night.

Anybody else have this pinpoint pupil problem?
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Old 03-04-2011, 07:24 PM
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Try going from a brightly lit room to a less lit ( but not completely dark) room. if you have severe visual blurring and eye pain ( like what happens when you walk into a brighlty lit room after an eye check up when they dilate your pupils) your pupils are too small ( but i find this highly unlikely). you should also have trouble driving because accomodation from near to far vision usually dilates pupils. obviously it is much harder to check if your eyes dilate than if your eyes constrict ( though you can induce this by pinching the side of the base of your neck ( trapezius muscle) on the side of the pupil you are checking)
There is no definition of "Normal" that fits everybody in medicine. "normal" is a statistical concept . If say 95% of people have a pulse rate between 60-90/min then that is taken as "normal" ( and it is). some athletes are perfectly healthy and have a pulse rate of 40/min ( eg usain bolt types). this doesnt make their body abnormal its just the tone of their heart muscle is better.
Causes of pinpoint pupil usually are associated with acute events like strokes ( usually in the pons) and drug overdoses (pesticides etc). to be honest with you , dont worry about it if you haven't got any symptoms.
Rule #1 in medicine : "if it ain't broke - don't fix it"
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Old 03-04-2011, 07:30 PM
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No, my pupils are definitely tiny, even in a dimly lit room. I realized this even before my car accident and seizure, when I was driving home from the store one night...I could barely see the road.

I don't know...a stroke is possible. I know the doctor treating me for Lyme Disease ran some clotting tests on me, and they did come back abnormal. She wants to start me on heparin, but all this seizure stuff is causing a delay with that.

I should add that I've already had an MRI and MRA, and both came back normal. Would either of these have indicated a stroke?

But wait...why would I even think this was a stroke if my symptoms with this event were identical to those of all my complex partial seizures? And I'm going to confess that I'm a little leary of your argument against what constitutes 'normal', too. Just because I'm not an MD doesn't mean I'm brain-dead and incapable of deciding what exactly is and is not normal for me. I would think that 'I' would be an expert on that subject, degree or no degree?

If I'm incapable of seeing the road at night because it appears too 'dim' due to what appear to me to be chronically constricted pupils, even in darkness, my pupils are very likely not large enough for conditions.

I notice you are studying to be a neurologist...please, please, please do not allow medical school to remove the logic and ability to think (rationally) that was given to you at birth. That is likely why I'm 46 year's old and only now having my seizures diagnosed...because so many doctors refused to believe that I had any 'expertise' in determining what was and was not normal...for me...at least until I crashed my car. And even now they want to treat me like I'm brain-dead...telling me that my OCD, Lyme, seizures are all unrelated...(which I don't believe!)

Last edited by elizzza811; 03-05-2011 at 11:26 AM.
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Old 03-06-2011, 03:21 PM
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first off , ease up - no one's calling you brain dead. Part of my job is just covering the bases ( 60% of patients thought "jaundice" meant vomiting - it doesnt make them brain dead , just misinformed). MRIs and MRAs usually pick up infarcts but can sometimes miss hemorrhages which CTs can pick up.
but if this is a chronic issue the MR imaging should have picked it up by now. I assure you that my ability to think and rationalise is not dimmed by 4 years of med school and that i am perfectly capable of reaching my own conclusions ( and as a fellow epileptic i can see things from the other side of the fence too.)
what must be stressed is that a pontine stroke should have had other symptoms besides the pinpoint pupils and given that it is a relatively acute phenomenon , would have led you to seek help early in most cases. The dimness in your vision could be caused by pupillary constriction - granted but it is unlikely to be a medically speaking "pinpoint pupil" per se. If you have a seizure your pupils should dilate in response to the stress on your body rather than constrict.But here we were discussing pinpoint pupils which are characteristically dots of pupils which DO NOT REACT to light or accomodation there are only 2 major causes ( which i have told you about).
Other pupillary abnormalities which can cause small pupils which REACT to EITHER light or accomodation or both are :
1) Diencephalic pupils ( small but react to light and accomodation) these are usually caused by a lesion in the thalamus and can also be caused by metabolic abnormalities ( you'll need a full biochemical workup to confirm this)
2)Midposition pupils which are small fixed to light but react to accomodation:
caused by lesions in the dorsal tectum
3) fixed irregular small pupils can be caused by nuclear midbrain lesions

All of this should have been picked up in an MRI if done by a competent radiologist.
I hope this has helped
(and pardon the line placement , for some reason its typing from the right)
Arvind
P.S. no need to get defensive - we're all here to help
.


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Old 03-06-2011, 07:13 PM
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I know...I'm sorry. I just feel like I'm in the situation I'm in today because so many doctors tried to tell me that everything was "all in my head"...literally...those were the words doctors used with me. So I have to admit I'm especially sensitive with doctors until they prove they are truly listening to me. And I just hope you never say something like this to your patients, because words like this hurt and affect a patient longterm.

OCD, chronic Lyme (which few doctors seem to believe in, with the exception of those who have chronic Lyme themselves and were helped by antibiotics), and now seizures, too.

See, back in fall of 2010 I saw my primary care physician and requested neurological testing. I wanted an MRA specifically because it felt as if my brain was not 'draining' properly (days these pinpoint pupils seemed tiniest!), BUT I was willing to compromise some and allow this physician to 'choose' the tests to be run on me herself...but she refused. She refused unless I was willing to furnish her with a copy of my psychiatric records. And I refused that, mostly because I didn't want to go down that road again. So I asked her instead for a referral to a neurologist (since she wasn't willing to take me seriously and look beyond my diagnosis of OCD), and she refused that as well! So there I was, sick, having severe neurological issues, and both of us had our heels dug in the ground. On top of that, she laughed at the fact that a nurse practitioner has been treating me on and off (off at that time) for chronic Lyme.

Needless to say, I never furnished her a copy of my psychiatric records because those affected with OCD seem to inherently know which symptoms and behaviors are OCD, and which aren't (myself included) - which is why OCD is so baffling to researchers in the first place. People affected with this disorder realize their OCD compulsions and rituals to clean, order, arrange, and check things are irrational, yet these behaviors continue to dominate their lives in spite of this realization. That is why I can say with confidence that my neurological symptoms (pinpoint pupils included) are not yet another manifestation of my OCD, or even an issue of...?...a more precise definition of what's 'normal'? I think I finally proved this back in December of 2010 when I landed my car in a ditch having a seizure.

I'm even more upset because after this incident with my primary care physician (but before my car accident), I actually found a neurologist a good distance from my home who didn't require a referral. But after the MRI and MRA she ordered came back normal, she just referred me to a rheumatologist due to an elevated RF (again). And then I crash my car seizuring after all this?

Sorry for throwing all of this at you, but I just believe there is more to be learned that what is to be found inside medical books, and I just wish more doctors would open their minds to ideas from 'little people' like me. You seem more open than doctors in the US, so thank you for that at least.
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Old 03-23-2011, 07:39 AM
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Elizzza,

Are the pinpoint pupils (Miosis) constant, or does it come or go? Does it last more than a half hour at a time?

Try looking at this:

Emergency Medicine. Go wayyyyyy down the page to "What the Pupils Indicate."

Quote :
Waxing and waning pupil size may indicate seizure activity, even without tonic-clonic movement.
And Wikipedia has something to say:
http://en.wikipedia.org/wiki/Miosis

Miosis and internal ophthalmoplegia as a manifestation of partial seizures.

Effects of Seizures on Autonomic and Cardiovascular Function

Are you on meds other than anti-seizure meds? One of the above citations, I don't remember which, mentioned some anti-depressants as causing miosis.

If your pinpoint pupils last over a half hour, on a regular basis, either it's not seizures, or you are often in status. If it's status, it needs to get stopped, now. If it's constant, it's probably time to look for another cause.
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  #7  
Old 03-23-2011, 09:52 AM
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Oh, no...it's definitely seizures after reading that. But during a seizure, like the one I had standing in front of a mirror OCD-ing my hands or something, my pupils actually enlarged briefly (normal size) before returning to pinpoint (abnormal). Am I backwards?

And what exactly is 'status'? I always have this feeling of pressure at the base of my skull - could it be my vagus nerve? And wouldn't status show up on an EEG?

I am not on any medications whatsoever right now, and my pupils remain tiny 24/7. And I used to have beautifully reactive pupils that were larger than most people's, even in daylight, and even blinking could increase their size momentarily. In darkness, you could barely even see my eye color. But today they are just dots, no matter what the lighting.

MRI and MRA were both normal. A SPECT scan several years ago came back abnormal, with reduced blood flow to certain areas in my brain, but this was blamed on Lyme Disease. Can seizures affect blood flow?

I noticed in the one article though that microwave radiation can cause this constriction of the pupils, and I seriously believe a lot of my issues started when I was using a cordless phone heavily and the number of cell phone towers and wifi signals in my neighborhood began to increase exponentially. Maybe all the 'electrosmog' in the environment is preventing my neurons from communicating???
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Old 03-23-2011, 11:39 AM
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Status Epilepticus = a seizure that lasts over 30 minutes. Very serious. If you have a seizure that lasts over 5 minutes it's time to call 9-1-1 or have a friend drive you in to the ER.

Status Epilepticus
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Old 03-23-2011, 11:45 AM
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I always thought it's been 5 minutes that defines status.

Quote :
More recently, authors suggest that SE be defined as any seizure lasting longer than 5 minutes based on natural history data that show typical generalized convulsive seizures that resolve spontaneously after 3-5 minutes
http://emedicine.medscape.com/article/1164462-overview
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Old 03-23-2011, 12:09 PM
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You are right, Eric. Some literature does say that. Some says 5 min., some say 10 min., some says 30 min., some says that a person is at risk of status if it is over 5 min. Some say 5 minutes for a generalized seizure and 30 for a partial seizure.

Ten minutes: http://www.epilepsyfoundation.org/ab...pilepticus.cfm
At risk (call 911) after 5 min: http://www.epilepsy.com/epilepsy/what_seizure_emergency
Thirty minutes: http://www.aafp.org/afp/2003/0801/p469.html
Five/Thirty: http://www.ilae-epilepsy.org/visitor...pilepticus.pdf
Five to Ten: http://www.epilepsy-society.org.au/p...pilepticus.pdf


I think they need to get together and come to some kind of agreement on it. A panel on epilepsy is said to do that, but there is still much vaguenrss and disagreement. The one thing they do seem to agree on is calling emergency services after 5 min.
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Old 03-23-2011, 11:44 PM
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But how do you determine whether you're having back to back seizures or in one continuous 'status' seizure? When I'm having multiples close together, it's hard to tell. I may have actually been in status at least once, because with this last seizure especially, my neighbor said I wasn't coming out of it, which is why she dialed 911.
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Old 03-24-2011, 12:29 AM
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multiples close together are also considered status under some circumstances. See links inside thread, below.


Blown Pupil?

Last edited by Endless; 03-24-2011 at 12:57 AM. Reason: inserted link
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Old 03-29-2011, 03:45 PM
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Does anyone here know if blurry vision is related to seizures? Periodically my vision will blur for an entire day or more in one or both eyes. Yesterday it was my left eye that got blurry, though vision in my right eye was crystal clear. Today my vision is blurred in both eyes.

Like I said, it comes and goes, but today I can't even read the numbers on my wall calendar.
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Old 12-05-2011, 08:23 AM
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Originally Posted by elizzza811 View Post:
Does anyone here know if blurry vision is related to seizures? Periodically my vision will blur for an entire day or more in one or both eyes. Yesterday it was my left eye that got blurry, though vision in my right eye was crystal clear. Today my vision is blurred in both eyes.

Like I said, it comes and goes, but today I can't even read the numbers on my wall calendar.
That could be a reaction to whatever medication you're taking.
That happened to me when I was on tegratol.
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Old 12-05-2011, 10:39 AM
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Same thing has happened to me because of Lamictal. I had perfect, glasses-free vision before I went on it, now I got the blurries coming and going through out the day, worse at night.
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Old 12-05-2011, 12:25 PM
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you shouldn't be driving because you have seizures
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Old 12-05-2011, 05:56 PM
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Still looking for different causes of small pupils that dont react to darknest. What meds might cause this ? What past eye disease could cause? Heres what I know for sure 1. iritus 2 . floating bodies left eye 3. Left eye iris adhesions but Dr. said leave alone til sight really bad ( now blurry ) 4. heart meds 5. chronic proxysymal hemia cranis I rrealize these symptoms et cetera are all over the board but all I have . NO Seizures as such Well thanks later tomorrow john
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Old 12-05-2011, 06:41 PM
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Originally Posted by Endless View Post:
Status Epilepticus = a seizure that lasts over 30 minutes. Very serious. If you have a seizure that lasts over 5 minutes it's time to call 9-1-1 or have a friend drive you in to the ER.

Status Epilepticus
what authorization does the hospital have at that point?
is a patient in status ep. basically a corpse?
does a patient then have any rights as an individual in a state of status epilepticus?
what if a doctor determines a lobotomy or implant is necessary at that point - is there any individual patient's right any more?
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Old 12-06-2011, 08:43 AM
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I don't know the answer to your question, but I do have one of my own.

Why go to the ER if you or someone with you thinks you're in 'status'? All the ER did was a chest x-ray on me even though I was breathing just fine, just because I'm a smoker. In fact, every time I've gone to the ER for anything, that's what they've done...searched for that long-awaited lung tumor. They didn't do a single neurological test on me, even when the ambulance personnel suspected seizures. I still can't get over that. No EEG in the ER following a MVA when a seizure is suspected? Can't get over it. No wonder it took 46 years for me to be diagnosed.
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Old 12-07-2011, 05:56 PM
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Originally Posted by elizzza811 View Post:
I don't know the answer to your question, but I do have one of my own.

Why go to the ER if you or someone with you thinks you're in 'status'? All the ER did was a chest x-ray on me even though I was breathing just fine, just because I'm a smoker. In fact, every time I've gone to the ER for anything, that's what they've done...searched for that long-awaited lung tumor. They didn't do a single neurological test on me, even when the ambulance personnel suspected seizures. I still can't get over that. No EEG in the ER following a MVA when a seizure is suspected? Can't get over it. No wonder it took 46 years for me to be diagnosed.
in my albeit limited experience, "seizure and ER" go together like "Ming vase and baseball bat"
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