Abnormal neurological pupil index is associated with malignant cerebral edema after mechanical thrombectomy in large vessel occlusion patients

Dowlati, Ehsan; Sarpong, Kwadwo; Kamande, Stanley; Carroll, Austin H.; Murray, Jerome; Wiley, Alynna; Peterson, B.; Jeffrey, C.; Chang, Jason J.; Aulisi, Edward F.; Armonda, Rocco A.; Felbaum, Daniel R.

doi:10.1007/s10072-021-05218-x

Cited by 10 publications

(10 citation statements)

References 42 publications

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“…Admission plasma glucose has been demonstrated to be a risk factor associated with CED after acute ischemic stroke in previous studies (Shimoyama et al, 2014;Cheng et al, 2020;Dowlati et al, 2021). However, our findings showed that the RPG was not associated with this outcome, while the SHR was independently associated with a higher degree of CED, 90-day poor functional outcome, and 90-day death, and the predictive value of the SHR (as a continuous variable) for moderate-tosevere CED and 90-day poor functional outcome, indicated by the AUC, was better than that of the RPG or FPG.…”

Section: Discussionmentioning

confidence: 94%

The stress hyperglycemia ratio is associated with the development of cerebral edema and poor functional outcome in patients with acute cerebral infarction

Deng

Liu

et al. 2022

Front. Aging Neurosci.

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Background and purposeAbsolute hyperglycemia at admission has been shown to be associated with the development of cerebral edema (CED) after acute cerebral infarction. Stress hyperglycemia is a more objective reflection of hyperglycemic state than absolute hyperglycemia. However, studies on the associations between stress hyperglycemia and CED are limited. We aimed to explore the associations of stress hyperglycemia, measured by stress hyperglycemia ratio (SHR), with the development of CED and poor functional outcome of acute cerebral infarction.MethodsPatients with acute middle artery cerebral infarction admitted to the Department of Neurology, West China Hospital of Sichuan University, within 24 h of symptom onset from January 2017 to March 2021 were included. Stress hyperglycemia was assessed by the SHR: admission fasting plasma glucose (FPG)/hemoglobin A1c (HbA1c). The primary outcome was the degree of CED evaluated on brain image. The secondary outcomes were moderate-to-severe CED, poor functional outcome (modified Rankin Scale score > 2), and death at 90 days. The associations between the SHR and outcomes were assessed with multivariate logistic regression analyses. We further compared the predictive value of the SHR, admission random plasma glucose (RPG), and admission FPG for outcomes in the training dataset and validation dataset.Results638 patients were enrolled. Each 0.1-point increase in the SHR was independently associated with a 1.31-fold increased risk of a higher degree of CED [odds ratio (OR): 1.31 (95% confidence interval (CI): 1.20–1.42), P < 0.001]. The SHR was independently associated with moderate-to-severe CED [per 0.1-point increase: OR: 1.39 (95% CI: 1.24–1.57), P < 0.001], poor functional outcome [per 0.1-point increase: OR: 1.25 (95% CI: 1.12–1.40), P < 0.001], and death [per 0.1-point increase: OR: 1.13 (95% CI: 1.03–1.25), P < 0.05]. The predictive value of the SHR (as a continuous variable), exhibited by the area under the curve in receiver operating characteristic analysis, was higher than that of the RPG and FPG for moderate-to-severe CED and poor functional outcome (P < 0.05).ConclusionThe SHR is independently associated with the severity of CED, poor functional outcome, and death after acute cerebral infarction, and the SHR (as a continuous variable) has a better predictive value for moderate-to-severe CED and poor functional outcome than the RPG and FPG.

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Section: Discussionmentioning

confidence: 94%

The stress hyperglycemia ratio is associated with the development of cerebral edema and poor functional outcome in patients with acute cerebral infarction

Deng

Liu

et al. 2022

Front. Aging Neurosci.

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“…In addition, abnormal NPi values ( < 3.0) on the ipsilateral side of stroke lesions within 72 hours after mechanical thrombectomy had a strong independent association with malignant cerebral edema in patients with large vessel occlusion (odds ratio, 21.80; 95% confidence interval [CI], 3.32-286.4) [1].…”

Section: Monitoring In Patients With Increased Icp and Strokementioning

confidence: 98%

“…In particular, evaluating PLR ≥ 72 hours after the return of spontaneous circulation (ROSC) using a quantitative pupillometer is emerging as a helpful examination to evaluate brainstem function in post-CA patients [26,27]. Several studies have evaluated the relationship between pupillometer parameters and prognostication following CA (Table 2) [1,11,12,[28][29][30][31][32][33][34][35]. A prospective study of out-of-hospital cardiac arrest (OHCA) patients treated with targeted temperature management (TTM) at 33°C with sedation and neuromuscular blocking agents reported that the quantitative %CH on days 1 and 2 were associated with poor outcomes at 90 days (cerebral performance categories [CPCs] 3-5).…”

Section: Prognosis In Patients With Post-cardiac Arrestmentioning

confidence: 99%

“…Intensive neurological examination is the most relevant diagnostic evaluation of neurological status at the bedside in patients with brain injury due to multiple etiologies and conditions predisposing them to neurological deterioration in the neurological intensive care unit (neuroICU). Monitoring of the pupillary light reflex (PLR) is a standard examination for detecting changes in cerebral dysfunction in patients with known brain injuries [1][2][3][4]. Quantitative pupillometry is an important noninvasive monitoring method of PLR that provides an objective measure of pupil diameter and pupillary reactivity [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

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Quantitative assessments of pupillary light reflexes in neurocritically ill patients

Kim

2022

J Neurocrit Care

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The pupillary light reflex (PLR) is a component of bedside neurological examinations in neurological intensive care units (neuroICUs). A quantitative pupillometer provides a non-invasive and objective pupil reactivity parameter clinically significant for changes in PLR in neuroICUs. This article reviews the physiology and importance of the PLR and the parameters of quantitative pupillometers. Moreover, this review discusses the clinical applications of quantitative pupillometers for post-cardiac arrest prognostication and monitoring of elevated intracranial pressure and neurological worsening in stroke, seizures, and other neurological diseases in the neuroICU. Quantitative pupillometry is a routine part of neurological examinations and an important monitoring tool for neurological diseases in neuroICUs.

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“…Yet, there are only few studies assessing the prognostic performance of automated pupillometry in ischemic stroke patients, and the exact time-point of pupillary light reflex deterioration in relation to EVT has so far not been analyzed in these studies [ 13 , 14 , 19 ]. The clinical value of this non-invasive technique especially in the early phase after EVT in LVO patients is therefore still not fully evaluated.…”

Section: Introductionmentioning

confidence: 99%

Pupillometry in the follow-up of patients undergoing EVT - prediction of space-occupying hemispheric infarction

Kossel,

Kobus,

Borutta

et al. 2023

J Neurol

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Background Despite benefits of endovascular treatment (EVT) for large vessel occlusion (LVO) ischemic stroke, space-occupying brain edema (BE) represents a detrimental complication. In critical-care settings, CT-imaging is needed for monitoring these patients. Yet, bed-side techniques with the potential to predict whether patients develop BE or not would facilitate a time- and cost-efficient patient care. We assessed clinical significance of automated pupillometry in the follow-up of patients undergoing EVT. Methods From 10/2018 to 10/2021, neurocritical-care-unit patients were retrospectively enrolled after EVT of anterior circulation LVO. We monitored parameters of pupillary reactivity [light-reflex-latency (Lat), constriction- and redilation-velocities (CV, DV), percentage-change-of-apertures (per-change); NeurOptics-pupilometer®] up to every hour on day 1–3 of ICU stay. BE was defined as midline shift ≥ 5 mm on follow-up imaging 3–5 days after EVT. We calculated mean values of intra-individual differences between successive pairs of parameters (mean-deltas), determined best discriminative cut-off values for BE development (ROC-analyses), and evaluated prognostic performance of pupillometry for BE development (sensitivity/specificity/positive-/negative-predictive-values). Results 3241 pupillary assessments of 122 patients [67 women, 73 years (61.0–85.0)] were included. 13/122 patients developed BE. Patients with BE had significantly lower CVs, DVs, and smaller per-changes than patients without BE. On day 1 after EVT mean-deltas of CV, DV, and per-changes were significantly lower in patients with than without BE. Positive-predictive-values of calculated thresholds to discriminate both groups were considerably low, yet, we found high negative-predictive-values for CV, DV, per-changes, and mean-deltas (max.: 98.4%). Conclusion Our data suggest associations between noninvasively detected changes in pupillary reactivity and BE early after LVO-EVT. Pupillometry may identify patients who are unlikely to develop BE and may not need repetitive follow-up-imaging or rescue-therapy.

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Abnormal neurological pupil index is associated with malignant cerebral edema after mechanical thrombectomy in large vessel occlusion patients

Cited by 10 publications

References 42 publications

The stress hyperglycemia ratio is associated with the development of cerebral edema and poor functional outcome in patients with acute cerebral infarction

The stress hyperglycemia ratio is associated with the development of cerebral edema and poor functional outcome in patients with acute cerebral infarction

Quantitative assessments of pupillary light reflexes in neurocritically ill patients

Pupillometry in the follow-up of patients undergoing EVT - prediction of space-occupying hemispheric infarction

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