Ultrasound examination of the pupil suggestive for carotid dissection

Farina, Filippo; Brunner, Cornelia; Schreiber, Stephan J.; Palmieri, Anna; Struhal, Walter; Baracchini, Claudio; Voško, Milan R.

doi:10.1212/wnl.0000000000004299

Cited by 6 publications

(4 citation statements)

References 1 publication

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“…Also, the new method proposed here may be a useful and practical tool to reveal subclinical changes in pupillary function. For example, in patients with mild clinical symptoms, with clinically suspected carotid dissection or brainstem injury, pupillary ultrasound assessment may help select patients suitable for emergency neuroimaging examination 22 . This technique may have potential applications in the study of pupillary function in neurodegenerative and neuroin ammatory diseases.…”

Section: Discussionmentioning

confidence: 99%

Utility of M-mode ultrasound for pupillary assessment in patients with traumatic brain injury

Fu¹,

Li²,

Yu³

et al. 2022

Preprint

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Background Pupillary assessment is an important index to evaluate changes in the conditions of patients with traumatic brain injury (TBI). This study assessed the utility of M-mode ultrasound as a non-invasive bedside assessment to evaluate pupillary light reflex (PLR) sensitivity in patients with TBI. Methods This is a prospective observational study of patients with TBI. Patients were divided into brisk, sluggish, or absent groups based on their PLR sensitivity. M-mode ultrasound was performed according to standard operation guidelines using a standardized light stimulus.Pupillary diameter (PD) and PLR sensitivity were recorded. At the same time, the pupil was examined by M-mode ultrasound, and the diameter and pupillary contraction time (PCT) were measured at rest, ipsilateral opposite PLR, and contralateral opposite PLR. Results A total of 150 participants were included. In the briskgroup, during the ipsilaterallight reflex, the left and right PCTs were 0.09 ± 0.02s and 0.10 ± 0.09s, respectively, and the pupillary diameter variation rates (PDVRs) were 0.36 ± 0.10 and 0.35 ± 0.09. In the sluggish group, during the ipsilateral light reflex, the left and right PCTs were 0.20 ± 0.05s and 0.19 ±0.03s, respectively. PDVRs were 0.18 ± 0.07 and 0.19 ± 0.11, respectively. In the brisk group, the cut-off value of PDVR of ipsilateral PLR was 0.205, AUC value was 0.957, and sensitivity and specificity were 95.3% and 90.8%, the cut-off value of PDVR of contralateral PLR was 0.146, AUC value was 0.962, and sensitivity and specificity were 95.3% and 86.2%. Conclusions This study demonstrated the usefulness of M-mode ultrasound for quantitative evaluation of pupillary changes. It is a simple, rapid, and objective method that can accurately monitor PD and sensitivity to light reflex, especially in patients with eyelid edema or TBI, where pupils cannot be examined visually.

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Section: Discussionmentioning

confidence: 99%

Utility of M-mode ultrasound for pupillary assessment in patients with traumatic brain injury

Fu¹,

Li²,

Yu³

et al. 2022

Preprint

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“…To test the CR, a painful stimulation (pinching) should be applied at the base of the neck on the trapezius muscle ipsilaterally to the tested eye. The stimulus should be vigorous in order to achieve a reliable CR [30] (Fig. 25.3).…”

Section: Pupil: Ultrasound Examinationmentioning

confidence: 99%

Carotid Dissection in ICU: Usefulness of Bedside Ultrasound Examination and Pupillary Early Approach

Baracchini

Farina

2021

Neurosonology in Critical Care

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A carotid artery dissection (CAD) is often an obscure and unrecognized cause of stroke. 2. A polytraumatic patient admitted to the ICU with a CAD carries a 70% risk of stroke. 3. Ultrasound is the most widely available and rapidly accessible tool for CAD screening. 4. Daily monitoring is mandatory as multivessel dissection develops in up to 25% of cases in the first week of hospitalization. 5. Bedside ultrasound examination of the pupil might reveal a subtle pupillary dysfunction determined by a hidden distal CAD. IntroductionCarotid artery dissection (CAD) is a major cause of ischemic stroke in young and middle-aged adults accounting for up to 25% of cases, with a mean age of occurrence of 44 years [1,2].In population-based studies, the annual incidence of internal carotid artery (ICA) dissection (ICAD) is estimated to be about 1.7 new cases/100.000; common carotid artery (CCA) dissections are very rare (<1% of all CADs) [3]. The true incidence of CAD is probably underestimated, because cases of CAD with little or no clinical signs -mainly non-ischemic CADs -are likely to remain undiagnosed [4].

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“…In 2009, Sargsyan et al showed in a traumatized patient with eyelid swelling that ultrasound examination of the eye could provide clear and precise visualization of spatial and temporal parameters of the pupils [10]. More recently, we pointed out the utility of ultrasound pupillometry (UP) in a patient with spontaneous dissection of the distal internal carotid artery segment [11]. In light of these findings, we aimed to establish the feasibility and reproducibility of UP in comparison with IVP and obtain values for PLR and CR in neuro-ophthalmologically healthy subjects.…”

Section: Introductionmentioning

confidence: 96%

Ultrasound Examination of the Pupil – A New Tool for the Neuro-Ophthalmological Assessment

et al. 2020

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Background Pupil examination represents a diagnostic and prognostic test in the management of several neurological diseases. Infrared video pupillometry (IVP) is the gold standard, since it is not routinely available, a noninvasive bedside ultrasound assessment has been proposed as an alternative. The aim of this study was to assess the feasibility and reproducibility of ultrasound pupillometry (UP) in comparison with IVP. Materials and Methods 81 subjects (43 men and 38 women, mean age: 52 ± 20 years and 49 ± 19 years, respectively) with no history of neurophthalmologic disease were enrolled. UP was performed with a 12-MHz linear probe according to current guidelines for orbital insonation. Light and painful stimuli were applied to test pupillary light reflex (PLR) and ciliospinal reflex (CR). In 30 of these subjects IVP examination was performed additionally to obtain intra-observer and inter-observer agreement. Results Increasing age was associated with a decreased pupillary diameter (PD) at rest, after PLR and CR (R –0.728, p < 0.01, R –0.643, p < 0.01, R 0.674, p < 0.001 respectively), while no association was noticed with time to constriction/dilation. UP measurements were reproducible (rate of inter- and intra-observer agreement: R 0.979, p < 0.01, R 0.946, p < 0.01 respectively) and concordant with IVP (PLR R 0.831, p < 0.01; CR R 0.879, p < 0.01). Conclusion According to our study, ultrasound pupillometry is a feasible and reliable technique for bedside pupillary function assessment, and is a good alternative to infrared video pupillometry. Moreover, it represents the only way for functional pupillary assessment in patients with periorbital hematoma.

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Ultrasound examination of the pupil suggestive for carotid dissection

Cited by 6 publications

References 1 publication

Utility of M-mode ultrasound for pupillary assessment in patients with traumatic brain injury

Utility of M-mode ultrasound for pupillary assessment in patients with traumatic brain injury

Carotid Dissection in ICU: Usefulness of Bedside Ultrasound Examination and Pupillary Early Approach

Ultrasound Examination of the Pupil – A New Tool for the Neuro-Ophthalmological Assessment

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