The Pupillary Light Reflex as a Biomarker of Concussion

Frederick, Carrick; Azzolino, Sergio; Hunfalvay, Melissa; Pagnacco, Guido; Oggero, Elena; D’Arcy, Ryan C.N.; Abdulrahman, Mahera; Sugaya, Kimio

doi:10.3390/life11101104

Cited by 10 publications

(16 citation statements)

References 45 publications

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“…6), where emergency medicine suggested “sideline observation for worsening symptoms” and athletic trainers suggested ED referral. A recent retrospective study determined that a concussive injury to the brain was associated with changes in the pupillary light reflex and subsequently pupillary asymmetry 26 . As studies continue to be conducted regarding objective methods of detecting concussions in children using salivary microRNA in real time, 27 practice guidelines should be established specific to pediatric athletes who sustain a concussion with isolated pupil asymmetry, without altered level of consciousness or other concerning neurologic signs, as set forth by PECARN and NATA.…”

Section: Discussionmentioning

confidence: 99%

Management of Acute Injury and Illness in Pediatric Athletes by Athletic Trainers

Cusack,

Cash,

Tuohy

et al. 2023

Pediatr Emer Care

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Objective This study aimed to determine athletic trainer compliance with emergency medicine and athletic training evidence-based guidelines for the on-the-field management of common pediatric sports-related injury and illness. Methods A questionnaire was distributed electronically to selected members of the National Athletic Trainer Association. The questionnaire included 10 clinical scenarios describing common sports-related injury/illness (closed head injury, cervical spine injury, blunt chest injury, blunt abdominal injury, ankle injury, knee injury with laceration, heat-related illness). On-the-field management decisions for each scenario were compared with selected emergency medicine and athletic training guidelines. Results Analysis was performed on 564 completed questionnaires (9% response rate). Responders were compliant with practice guidelines for both emergency medicine and athletic training except for blunt chest trauma with tachycardia, closed head injury with loss of consciousness, closed head injury with repetitive speech, closed head injury with a fall higher than 5 feet, cervical spine injury with paresthesias, and heat-related illness with persistent symptoms. Discrepancies between emergency medicine and athletic training guidelines included closed head injury with repetitive speech, closed head injury and height of fall, closed head injury and unequal pupils, and cervical spine injury with neck pain and paresthesias. Conclusions Based on our sample, athletic trainers were compliant with many guidelines supported by both emergency medicine and athletic training. We identified several deficiencies in the availability of evidence-based guidelines and discrepancies between these guidelines and athletic trainer responses. To provide optimal care to pediatric athletes who sustain injury or illness, emergency medicine and athletic training organizations should collaborate to improve these discrepancies.

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Section: Discussionmentioning

confidence: 99%

Management of Acute Injury and Illness in Pediatric Athletes by Athletic Trainers

Cusack,

Cash,

Tuohy

et al. 2023

Pediatr Emer Care

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“…However, impaired pupillary responses can occur without damage to the neural integrity of the visual system as exemplified by arousal, which can trigger a pupillary response independent of the visual system (Bradley et al, 2008;Tapper et al, 2021). The PLR is more than just a reflex as it is influenced significantly by central brain function (Carrick et al, 2021). Patients who present with TBI commonly have associated pupillary abnormalities (Helmy et al, 2012).…”

Section: The Pupil and Tbimentioning

confidence: 99%

Traumatic brain injury: Mechanisms, manifestations, and visual sequelae

et al. 2023

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Traumatic brain injury (TBI) results when external physical forces impact the head with sufficient intensity to cause damage to the brain. TBI can be mild, moderate, or severe and may have long-term consequences including visual difficulties, cognitive deficits, headache, pain, sleep disturbances, and post-traumatic epilepsy. Disruption of the normal functioning of the brain leads to a cascade of effects with molecular and anatomical changes, persistent neuronal hyperexcitation, neuroinflammation, and neuronal loss. Destructive processes that occur at the cellular and molecular level lead to inflammation, oxidative stress, calcium dysregulation, and apoptosis. Vascular damage, ischemia and loss of blood brain barrier integrity contribute to destruction of brain tissue. This review focuses on the cellular damage incited during TBI and the frequently life-altering lasting effects of this destruction on vision, cognition, balance, and sleep. The wide range of visual complaints associated with TBI are addressed and repair processes where there is potential for intervention and neuronal preservation are highlighted.

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“…With the nearly universal availability of smartphones, they have found innovative uses in various clinical scenarios. [ 18 19 20 21 ] Recently, several smartphone-based pupillometer applications have been introduced to assess the absolute pupil measurements as well as the relative change in pupil size using the device’s built-in flash. Smartphone pupillometers have the advantage of being more affordable, portable, and accessible.…”

Section: Introductionmentioning

confidence: 99%

Interdevice Agreement between a Smartphone and a Commercial Pupillometer

Rattan,

Girgla,

Mahajan

et al. 2024

International Journal of Applied &Amp; Basic Medical Research

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Background: The reliability of dynamic pupillometry parameters varies from one pupillometer to another, making it difficult to standardize the values for any particular device. Hence, further studies are required to evaluate the agreement of various pupillometer devices and explore their utility in routine clinical settings. Aim: This study sought to evaluate the agreement between smartphone and commercial pupillometer measurements in routine clinical settings. Methods: The study included pupillary measurements obtained by a single investigator from 100 healthy participants (200 eyes) with each pupillometer. Pupillary measurements taken by a smartphone pupillometry application (reflex pupillary light reflex analyzer by Brightlamp [Indianapolis, IN, USA]) were compared with a commercial pupillometer (neurological pupil index-200, NeurOptics Inc., Irvine, USA). Results: The comparison of descriptive statistics revealed a statistically significant difference between the smartphone and commercial pupillometers for various parameters, including maximum diameter, minimum diameter, constriction velocity (CV), maximum CV, and dilatation velocity (P < 0.05), except for latency (P = 0.36). The intraclass correlation coefficient revealed poor agreement between the two devices (<0.50). Conclusion: The measurements by smartphone pupillometry application were found to be unreliable, indicating that they may not be an ideal substitute for commercial pupillometers in their present form in the Indian population. Further studies with larger sample size as well as improvements in the processing and interpretation of the measurements by the software, are needed to determine its utility in routine clinical settings.

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The Pupillary Light Reflex as a Biomarker of Concussion

Cited by 10 publications

References 45 publications

Management of Acute Injury and Illness in Pediatric Athletes by Athletic Trainers

Management of Acute Injury and Illness in Pediatric Athletes by Athletic Trainers

Traumatic brain injury: Mechanisms, manifestations, and visual sequelae

Interdevice Agreement between a Smartphone and a Commercial Pupillometer

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