A differential of the left eye and right eye neurological pupil index is associated with discharge modified Rankin scores in neurologically injured patients

Privitera, Claudio M.; Neerukonda, Sanjay V.; Aiyagari, Venkatesh; Yokobori, Shoji; Puccio, Ava M.; Schneider, Nathan J.; Stutzman, Sonja E.; Olson, DaiWai M.; Hill, Michelle; DeWitt, Jessica; Atem, Folefac; Barnes, Arianna; Xie, Daxing; Kuramatsu, Joji B.; Koehn, Julia; Swab, Stefan

doi:10.1186/s12883-022-02801-3

Cited by 14 publications

(12 citation statements)

References 54 publications

(62 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The wellknown association of pupillary response with neurologic pathways has supported the use of QP as a routinely employed and effective measure in the assessment and prediction of outcomes for patients with diverse pathologies spanning traumatic brain injury and other neurological issues. [6][7][8][9][10] Already widely in use in critical care settings and with documented applications in the detection of neurological injuries and determination of efficacy of different interventions, QP may present value to emergency clinicians as a non-invasive, rapid, and precise diagnostic approach for use in the detection and treatment of intoxicated patients. Whether QP can be used to assess patients for intoxication or from ethanol or key drugs of abuse, and whether QP measurements of mental status change would be made unreliable because of intoxicated states, remains unknown.…”

Section: Background and Importancementioning

confidence: 99%

“…Quantitative pupillometry (QP) represents the automated, electronic measurement of pupillary size and light reactivity, including variables such as constriction velocity, latency, and more. The well‐known association of pupillary response with neurologic pathways has supported the use of QP as a routinely employed and effective measure in the assessment and prediction of outcomes for patients with diverse pathologies spanning traumatic brain injury and other neurological issues 6–10 …”

Section: Introductionmentioning

confidence: 99%

“…The well‐known association of pupillary response with neurologic pathways has supported the use of QP as a routinely employed and effective measure in the assessment and prediction of outcomes for patients with diverse pathologies spanning traumatic brain injury and other neurological issues. 6 , 7 , 8 , 9 , 10 …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Impact of acute intoxication on quantitative pupillometry assessment in the emergency department

et al. 2022

View full text Add to dashboard Cite

show abstract

Section: Background and Importancementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of acute intoxication on quantitative pupillometry assessment in the emergency department

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Although developed roughly 100 years ago, the success of Seldinger’s work in the 1950s spawned a steady increase in the type, frequency and availability of angiography globally 11. The advantages of pupillometry are well documented in providing new metrics with higher accuracy, precision and reliability than subjective PLR assessment 12–15. What remains unknown is whether changes in PLR metrics can be attributed to periprocedural events or whether these changes reflect new or worsening neurological deficits.…”

Section: Introductionmentioning

confidence: 99%

Prospective study examining the impact of cerebral angiography on quantitative pupillometer values in the interventional radiology suite

Nguyen,

Marshall,

Rana

et al. 2024

BMJ Open

Self Cite

View full text Add to dashboard Cite

ObjectivesThe purpose of this pilot study was to obtain baseline quantitative pupillometry (QP) measurements before and after catheter-directed cerebral angiography (DCA) to explore the hypothesis that cerebral angiography is an independent predictor of change in pupillary light reflex (PLR) metrics.DesignThis was a prospective, observational pilot study of PLR assessments obtained using QP 30 min before and after DCA. All patients had QP measurements performed with the NPi-300 (Neuroptics) pupillometer.SettingRecruitment was done at a single-centre, tertiary-care academic hospital and comprehensive stroke centre in Dallas, Texas.ParticipantsFifty participants were recruited undergoing elective or emergent angiography. Inclusion criteria were a physician-ordered interventional neuroradiological procedure, at least 18 years of age, no contraindications to PLR assessment with QP, and nursing transport to and from DCA. Patients with a history of eye surgery were excluded.Main outcome measuresDifference in PLR metric obtained from QP 30 min before and after DCA.ResultsStatistically significant difference was noted in the pre and post left eye readings for the minimum pupil size (a.k.a., pupil diameter on maximum constriction). The mean maximum constriction diameter prior to angiogram of 3.2 (1.1) mm was statistically larger than after angiogram (2.9 (1.0) mm; p<0.05); however, this was not considered clinically significant. Comparisons for all other PLR metrics pre and post angiogram demonstrated no significant difference. Using change in NPi pre and post angiogram (Δpre=0.05 (0.77) vs Δpost=0.08 (0.67); p=0.62), we calculated the effect size as 0.042. Hence, detecting a statistically significant difference in NPi, if a difference exists, would require a sample size of ~6000 patients.ConclusionsOur study provides supportive data that in an uncomplicated angiogram, even with intervention, there is no effect on the PLR.

show abstract

“…The asymmetric dilation, also known as anisocoria, and decreased pupillary light reflex are associated with herniation and brainstem compression [ 6 ]. The Neurological Pupil index (NPi) is a measuring tool that assesses pupillary light reflex and is scored between 0 and 5 [ 6 , 7 ]. Scores greater than 3 are considered within the normal range while values less than 3 or equal to 0 are considered abnormal or non-reactive, respectively, and can be correlated with increased ICP [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Rapidly Progressive Fatal Pneumococcal Meningitis in a Fully Immunized Child With a History of Facial Bone Fractures

Stanley,

Rizvi,

Sahhar

2024

Cureus

View full text Add to dashboard Cite

Meningitis is the inflammation of meninges either septic or aseptic depending on the source of infection. Typical signs and symptoms of meningitis in children include fever, headache, neck stiffness, nuchal rigidity represented by positive Kernig and Brudzinski signs, photophobia, nausea, vomiting, confusion, lethargy, and irritability. Bacterial meningitis is commonly caused by Streptococcus pneumoniae in children over the age of three months. Although there has been a decline in infections due to the introduction of the pneumococcal conjugate and pneumococcal polysaccharide vaccines, there are still reported cases of invasive pneumococcal infections mostly with non-vaccine serotypes. We report a fully immunized six-year-old male patient with a presentation of classic meningitis signs and symptoms who developed rapid progression of disease including sudden and dramatic change in physical exam and subsequent respiratory depression within 12 hours of admission. Our patient had a history of extensive traumatic facial bone fractures six months prior. Our case demonstrates a unique presentation of rapidly progressing pneumococcal meningitis due to a suspected complication of septic thrombophlebitis and subsequent brain herniation in a fully immunized patient six months after a severe traumatic facial injury.

show abstract

A differential of the left eye and right eye neurological pupil index is associated with discharge modified Rankin scores in neurologically injured patients

Cited by 14 publications

References 54 publications

Impact of acute intoxication on quantitative pupillometry assessment in the emergency department

Impact of acute intoxication on quantitative pupillometry assessment in the emergency department

Prospective study examining the impact of cerebral angiography on quantitative pupillometer values in the interventional radiology suite

Rapidly Progressive Fatal Pneumococcal Meningitis in a Fully Immunized Child With a History of Facial Bone Fractures

Contact Info

Product

Resources

About