شاب عمره ٢٥ سنة في العناية بعد إصابة رأس مع نزيف في الجهة اليسرى. كان مستقراً، والآن حدقته اليسرى صارت ٦ ملم وبطيئة الاستجابة، والأخرى ٣ ملم وتستجيب، وصار أكثر نعاساً. ماذا يدل هذا؟

A 25-year-old in ICU after a head injury with left-sided haemorrhage had been stable. Now his left pupil is 6 mm and sluggish, the right is 3 mm and reactive, and he is drowsier. What does this indicate?

1. A sign that intracranial pressure is improving
2. A normal pupil difference seen in most people
3. Third-nerve compression, possibly early herniation
4. A normal effect of eye drops given yesterday

Answer: C) Third-nerve compression, possibly early herniation. A unilateral dilated, sluggish pupil after head injury suggests oculomotor nerve compression, usually from uncal herniation, and is reported immediately.