Automated Pupillometry and Detection of Clinical Transtentorial Brain Herniation: A Case Series

Papangelou, Alexander; Zink, Elizabeth K.; Chang, Wan Tsu W.; Frattalone, Anthony; Gergen, Daniel; Gottschalk, Allan; Geocadin, Romergryko G.

doi:10.1093/milmed/usx018

Cited by 39 publications

(23 citation statements)

References 43 publications

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“…However, in the setting of raised intracranial pressure or uncal herniation or any other neurological emergency, pupillary light response is used to monitor the patients. There have been attempts to use pupillography instead of simple clinical observation to detect a light response (172). Indices based on pupillography have been used, but it is not yet clear if pupillography adds information additional to simple observation.…”

Section: The Efferent Pupillary Pathway Author: Helmut Wilhelmmentioning

confidence: 99%

Standards in Pupillography

et al. 2019

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The number of research groups studying the pupil is increasing, as is the number of publications. Consequently, new standards in pupillography are needed to formalize the methodology including recording conditions, stimulus characteristics, as well as suitable parameters of evaluation. Since the description of intrinsically photosensitive retinal ganglion cells (ipRGCs) there has been an increased interest and broader application of pupillography in ophthalmology as well as other fields including psychology and chronobiology. Color pupillography plays an important role not only in research but also in clinical observational and therapy studies like gene therapy of hereditary retinal degenerations and psychopathology. Stimuli can vary in size, brightness, duration, and wavelength. Stimulus paradigms determine whether rhodopsin-driven rod responses, opsin-driven cone responses, or melanopsin-driven ipRGC responses are primarily elicited. Background illumination, adaptation state, and instruction for the participants will furthermore influence the results. This standard recommends a minimum set of variables to be used for pupillography and specified in the publication methodologies. Initiated at the 32nd International Pupil Colloquium 2017 in Morges, Switzerland, the aim of this manuscript is to outline standards in pupillography based on current knowledge and experience of pupil experts in order to achieve greater comparability of pupillographic studies. Such standards will particularly facilitate the proper application of pupillography by researchers new to the field. First we describe general standards, followed by specific suggestions concerning the demands of different targets of pupil research: the afferent and efferent reflex arc, pharmacology, psychology, sleepiness-related research and animal studies.

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Section: The Efferent Pupillary Pathway Author: Helmut Wilhelmmentioning

confidence: 99%

Standards in Pupillography

et al. 2019

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“…The automated pupillometry exam takes approximately 3 seconds to perform and has been studied in children of all ages without any adverse events, although it may be limited by patient cooperation in awake children. 7 Studies in adult patients support a potential role of the NPi assessed by AIP for prognostication after cardiac arrest and subarachnoid hemorrhage, [8][9][10][11][12] detection of significant intracranial events, [13][14][15] and elevated ICP, [16][17][18][19][20] and for detecting nonconvulsive status epilepticus. 21,22 Published literature established normative data PLR reference values in healthy children, but investigations of AIP use in neurocritically ill pediatric patients are limited to a single study on its use for detection of increased ICP.…”

Section: Introductionmentioning

confidence: 91%

Automated Infrared Pupillometer Use in Assessing the Neurological Status in Pediatric Neurocritical Care Patients: Case Reports and Literature Review

McGetrick

Schneider

Olson

et al. 2021

Journal of Child Science

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Automated infrared pupillometry (AIP) is rapidly becoming an accepted standard for the evaluation of pupil size and reactivity in adult neurocritical care. Recently, pediatric centers are increasingly utilizing this technology, but data supporting its use in children are limited. Our pediatric intensive care unit instituted AIP as a standard of care for pupillary light assessments in neurocritical care patients in early 2020. In this article, we describe four cases highlighting the advantage of using objective assessments of the pupillary light reactivity response measured by the Neurological Pupil index (NPi) to detect early changes in the patient's neurological status. These cases support the applicability of AIP in pediatric neurocritical care as a noninvasive neurologic monitoring tool. The NPi may be superior to manual pupil assessments by providing a numerical scale for accurate trending clinical status of a patient's neurologic condition.

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“…Previously discussed studies had noted improvement in the PLR after treatment of increased ICP or TTH, but those reports were descriptive, and the response was not systematically evaluated. 40,58,59 Taylor et al described 2 illustrative cases. In the first, the patient had sustained ICP >20 mm Hg and developed an unreactive pupil with CV <0.6 mm/s.…”

Section: Increased Icp and Herniationmentioning

confidence: 99%

“…58 In the study of 12 herniation events in 3 patients, Papangelou et al reported that NPi normalized with osmotic therapy after a median of 43 minutes. 59…”

Section: Applications Of Quantitative Pupillometrymentioning

confidence: 99%

Quantitative Pupillometry in the Intensive Care Unit

Bower

Sweidan

et al. 2019

J Intensive Care Med

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Quantitative pupillometry provides a noninvasive and objective assessment within the neurological examination. This review details the physiology of the pupillary light response, the clinical significance of changes in pupillary reactivity, and the variables that compose the Neurological Pupil index or NPi are discussed. This article reviews the most recent applications and advances in quantitative pupillometry for noninvasive intracranial pressure monitoring, postcardiac arrest prognostication, and subarachnoid hemorrhage. Also discussed are the limitations and confounders of quantitative pupillometry in the modern neurological intensive care unit.

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Automated Pupillometry and Detection of Clinical Transtentorial Brain Herniation: A Case Series

Cited by 39 publications

References 43 publications

Standards in Pupillography

Standards in Pupillography

Automated Infrared Pupillometer Use in Assessing the Neurological Status in Pediatric Neurocritical Care Patients: Case Reports and Literature Review

Quantitative Pupillometry in the Intensive Care Unit

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