Non-reactive unilateral right mydriasis in a 70-year-old woman with acute gastro-enteritis secondary to cholera

Abstract

Headaches, Dizziness and transient loss of consciousness are common early signs of neuropathology. In our settings, Hypoglycemia and Hypotension may present with either dizziness, loss of consciousness or both. With hypoglycemia causing decreased glucose supply to the brain and hypotension causing decreased blood supply to the brain. This case study looks at a case of a 70-year-old woman with acute gastro-enteritis 20 to cholera who presented unconscious to our facility with non-reactive unilateral mydriasis. She had rapidly received 5.5L of normal saline to correct her dehydration at a primary care point, where the unilateral mydriasis was first noticed. However, on development of lateralizing signs pathognomic of stroke, she was referred to our facility. Where we continued the rapid fluid and oxygen therapy. Until she was diagnosed with fluid overload and later died. The working explanation is that the non-reactive pupils were as a result of an increased intracranial pressure as a result of rapid rehydration causing neuronal deterioration leading to cerebral oedema. However, the lateralizing signs may also be linked with the unilateral mydriasis. Inability to perform an autopsy will elude us the chance of a 100% conclusive diagnosis.