This is because Horners syndrome and oculomotor nerve lesions both cause ptosis. Anisocoria is usually a benign finding, unaccompanied by other symptoms (physiological anisocoria). Old face photographs of patients often help to diagnose and establish the type of anisocoria. It should be considered an emergency if a patient develops acute onset anisocoria. These cases may be due to brain mass lesions which cause oculomotor nerve palsy. Anisocoria in the presence of confusion, decreased mental status, severe headache, or other neurological symptoms can forewarn a neurosurgical emergency. This is because a hemorrhage, tumor or another intracranial mass can enlarge to a size where the third cranial nerve (CN III) is compressed, which results in uninhibited dilatation of the pupil on the same side as the lesion. Popular culture
English singer David Bowie exhibited anisocoria, owing to a teenage injury. In the season 10 Big Bang Theory Comic-Con special, Steve Molaro told a story about how he first met actor Judd Hirsch and was taken aback by his dilated pupil. One of the other writers researched it and discovered that Judd Hirsch has anisocoria. American actress Melissa Benoist developed this condition in 2015. American artist Ze Frank has the condition. He was listed as second author on a paper published in The Journal of Neuroscience, which was featured briefly in episode 21 of the show named a show on May 25, 2012 called My Pupils, explaining that his study of neuroscience of vision was motivated by his harmless anisocoria condition.
Jugular foramen syndrome, or Vernets syndrome, is characterized by paresis of the glossopharyngeal, vagal, and accessory (with or without the hypoglossal) nerves. Symptoms
Symptoms of this syndrome are consequences of this paresis. As such, an affected patient may show:
dysphonia/hoarseness
soft palate dropping
deviation of the uvula towards the normal side
dysphagia
loss of sensory function from the posterior 1/3 of the tongue (CN IX)
decrease in the parotid gland secretion (CN IX)
loss of gag reflex
sternocleidomastoid and trapezius muscles paresis (CN XI)

Causes
Glomus tumors (most frequently)
Meningiomas
Schwannomas (Acoustic neuroma)
Metastatic tumors located at the cerebellopontine angle
Trauma
Fracture of occipital bone
Infections
Cholesteatoma (very rare)
Obstruction of the jugular foramen due to bone diseases
Nasopharyngeal carcinoma spreading into the parapharyngeal space involving the ninth, tenth, and eleventh cranial nerves

Diagnosis
Gadolinium enhanced mri for vestibular schwannoma
mri and biopsy for nasopharyngeal carcinoma
based on nerve palsies
NCCT for occipital bone fracture


== References ==