Unequal Pupils may indicate what?

• A. Skull fracture with exposed tissue
• B. Clear drainage from nose/ears
• C. Possible increased ICP or brain herniation
• D. Airway and rapid transport

Answer: (C)

Unequal pupils in head trauma point to a potential intracranial problem, such as increased intracranial pressure or brain herniation. The size and reactivity of the pupils reflect nerve functioning in the brainstem, and rising ICP can compress the oculomotor nerve, causing one pupil to become dilated and less reactive. This is a red flag because it signals that the brain is under pressure and shifting position, which can worsen quickly. In this context, recognizing anisocoria prompts urgent assessment and rapid transport with continuous monitoring.

Other signs you might encounter in head trauma, like skull fracture with exposed tissue or clear drainage from the nose or ears, indicate serious injuries but don’t specifically point to increased ICP or herniation. Prioritizing airway and rapid transport is always essential, but anisocoria specifically highlights a need to assume intracranial injury and act accordingly.