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A 58-year-old woman presents to the emergency department for headache and right eye pain. The symptoms started two days ago and have progressively worsened. The patient reports photosensitivity and sees a halo around lights. She has constant nausea and has vomited three times today. There has been no recent head trauma. Her past medical history includes migraines, for which she takes sumatriptan; however, this medication has not improved her current symptoms. Temperature is 37.0°C (98.6°F), pulse is 110/min, respiratory rate is 20/min, and blood pressure is 134/82 mmHg. Vision is 20/30 in the left eye and 20/70 in the right eye. Physical examination reveals dilation of the right pupil, which is non-reactive, and conjunctival injection (see the image below). Examination of the left eye is within normal limits. Which of the following additional findings would be consistent with the most likely diagnosis?
Image by James Heilman, MD is licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license. Reproduced from WikiCommons
Image by James Heilman, MD is licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license. Reproduced from WikiCommons
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