SHM Converge Scientific Abstract ePoster Gallery-A Stroke Alert Triggered by Unilateral Mydriasis: Identifying Chemical Exposure as a High-Value Stroke Mimic

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This document contains multiple abstract-like sections, but the main clinical case describes a 36-year-old woman who triggered a stroke alert after sudden unilateral left mydriasis with blurry vision and mild headache. Initial evaluation showed isolated pupillary dilation without ophthalmoplegia or focal neurologic deficits. Because acute anisocoria can signal serious conditions such as aneurysm, hemorrhage, or stroke, she underwent CT head, CT angiography of the head and neck, and laboratory testing, all of which were negative. Neurology initially recommended MRI brain and transthoracic echocardiography.<br /><br />After more detailed history, she reported prolonged exposure to open buckets of Pine-Sol while cleaning, with strong fumes and no glove use. Her symptoms were ultimately attributed to transient pharmacologic mydriasis from chemical exposure, likely related to volatile organic compounds in the cleaning agent. MRI and TTE were cancelled, and she was discharged with primary care follow-up.<br /><br />The discussion emphasizes that while stroke alert pathways appropriately prioritize safety, they can lead to extensive workups in stroke mimics. Environmental and occupational exposure history is important and may prevent unnecessary imaging, admission, and cost. The case also highlights that isolated unilateral mydriasis without ophthalmoplegia makes compressive third nerve palsy less likely.<br /><br />The document also includes a separate residency-program innovation piece proposing an IMPACT framework for making resident committees more meaningful and measurable, as well as an AI workflow framework for program directors to reduce administrative burden through persistent context, automation, and delegated agents.

Asset Subtitle

Joy Jackson

Meta Tag

Author List Garrett Snyder, Joy Jackson, Sai Wan, Travis Brauer, Zein Barakat

Category Clinical Vignettes

Concept Anisocoria

Concept Neurologic Emergency

Concept Mydriasis

Concept Intracranial Hemorrhage

Concept Cranial Nerve III Compression

Distinguished Non-Finalist

Presenter Organization Lakeland Regional Hospital

Presenting Author Joy Jackson

Track Adult

Keywords

anisocoria

mydriasis

stroke alert

pharmacologic mydriasis

chemical exposure

Pine-Sol

stroke mimic

CT angiography

occupational history

resident committee framework

Anisocoria

Neurologic Emergency

Mydriasis

Intracranial Hemorrhage

Cranial Nerve III Compression