Objective Pupillometry as an Adjunct to Prediction and Assessment for Oculomotor Nerve Injury and Recovery: Potential for Practical Applications

Background: Oculomotor nerve palsy can be caused by diverse etiologies, but no report has yet documented its association with a cisternal drain. Case Description: A 35-year-old woman presented with severe headache. The patient did not exhibit oculomotor nerve palsy at presentation. Cranial computed tomography (CT) revealed diffuse subarachnoid hemorrhage. The patient underwent open microsurgical clipping of a ruptured middle cerebral artery aneurysm. During surgery, a cisternal drain was placed in the basal cistern at the medial aspect of the clinoidal portion of the internal carotid artery. The patient presented with the left oculomotor nerve palsy immediately after surgery. CT revealed displacement of the cisternal drain to the lateral aspect of the anterior clinoid process. The patient’s mydriasis and sluggish light reaction recovered after 7 days, while extraocular movements persisted for 50 days. The constructive interference steady-state sequence detected the left oculomotor nerve coursing adjacent to the clinoidal internal carotid artery. Conclusion: Oculomotor nerve palsy can be caused by collision with a thin silastic tube placed during surgery for aneurysmal subarachnoid hemorrhage. Withdrawal of the drain as early as possible is recommended when drain-associated oculomotor nerve palsy is suspected.

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“…[ 2 , 3 , 6 , 8 , 9 , 15 ] Complete recovery from isolated, traumatic oculomotor nerve palsy is generally rare. [ 1 , 10 , 17 ]…”

Section: Introductionmentioning

confidence: 99%

“…[2,3,6,8,9,15] Complete recovery from isolated, traumatic oculomotor nerve palsy is generally rare. [1,10,17] Here, we report a unique case of oculomotor nerve palsy, presumably caused by compression of a cisternal drain placed during surgery for aneurysmal subarachnoid hemorrhage.…”

Section: Introductionmentioning

confidence: 99%

Oculomotor nerve palsy presumably caused by cisternal drain during microsurgical clipping

Sugiyama¹,

Tsutsumi²,

Ishii³

2022

Surgical Neurology International

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“…Changes in pupil size and reactivity can provide early recognition of neurological decline and facilitate lifesaving interventions. [1][2][3][4] The standard of practice to evaluate PLR uses manual use of a penlight or similar light source; however, this method has low interrater reliability and intrarater consistency. 3 Automated infrared pupillometry (AIP) has greater reliability to obtain objective and accurate measurements of pupillary size and reactivity to light using the Neurological Pupil index (NPi).…”

mentioning

confidence: 99%

“…Assessing the pupillary light reflex (PLR) is a core component of neurological assessments. Changes in pupil size and reactivity can provide early recognition of neurological decline and facilitate lifesaving interventions 1–4. The standard of practice to evaluate PLR uses manual use of a penlight or similar light source; however, this method has low interrater reliability and intrarater consistency 3.…”

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confidence: 99%

Neurological Pupil Index as an Indicator of Irreversible Cerebral Edema: A Case Series

Cortes

Siaron

Nadim

et al. 2021

Journal of Neuroscience Nursing

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BACKGROUND: Assessing the pupillary light reflex is a core component of neurological assessments. Pupil size and reactivity can provide early warning about early neurological decline. Automated infrared pupillometry is noninvasive and easy to use and has greater reliability compared with manual assessments to obtain objective and consistent measurements of pupillary size and reactivity to light. METHODS: This is a case series of 3 patients who had poor baseline clinical neurological examinations. Because it would be more difficult to detect acute neurological deterioration, automated infrared pupillometry and the Neurological Pupil index (NPi) were used in addition to the clinical neurological examination. NPi values < 3.0 prompted further imaging. RESULTS: In each case, abnormal NPi values prompted emergent imaging that confirmed acute cerebral edema and resulted in a change in management and treatment plan. CONCLUSION: The automated infrared pupillometry is a noninvasive monitor that can provide additional objective data in patients with a poor baseline neurological examination in whom it may otherwise be difficult to detect neurological deterioration.

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Automated Pupillometry in Neurocritical Care: Research and Practice

Lussier

Olson

Aiyagari

2019

Curr Neurol Neurosci Rep

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Objective Pupillometry as an Adjunct to Prediction and Assessment for Oculomotor Nerve Injury and Recovery: Potential for Practical Applications

Cited by 10 publications

References 13 publications

Oculomotor nerve palsy presumably caused by cisternal drain during microsurgical clipping

Oculomotor nerve palsy presumably caused by cisternal drain during microsurgical clipping

Neurological Pupil Index as an Indicator of Irreversible Cerebral Edema: A Case Series

Automated Pupillometry in Neurocritical Care: Research and Practice

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