Concussion Alters Dynamic Pupillary Light Responses in Children

Abstract

Aim: To investigate the impact of concussion on pupillary function in children by examining pupillometric parameters and assessing for differences in children reporting photosensitivity. Methods: Retrospective chart review was performed of pediatric patients referred for visual symptoms after concussion from 2017 to 2018 seen in a single academic outpatient clinic. Pupillometry data of 92 patients were included. Outcomes were compared to normative pediatric data from the same institution by 2-sample t tests. The association between photosensitivity and each outcome was assessed by use of linear mixed models with photosensitivity as a fixed effect and random patient effect. Results: Outcomes of 181 eyes in 92 concussion patients were averaged by patient and compared to normative values in scotopic conditions. Concussion patients had an average age of 13.8 ± 2.64 years. Average constriction velocity ( P = .0008), maximum constriction velocity ( P = .0012), and average dilation velocity ( P = .0034) were faster in concussion patients, whereas 75% recovery times ( P = .0027) was increased. Photosensitivity did not significantly affect measured pupillary responses. Conclusion: Dynamic pupillary responses may be increased in pediatric concussion. Pupillometry may provide insight into the complex pathophysiological changes underlying pediatric concussion.

Accommodative and pupillary dysfunctions in concussion/mild traumatic brain injury: A Review

“…This would result in a bigger response amplitude, and by necessity a larger average/peak velocity, per the "main sequence" neurological relation: the larger the response amplitude, the greater the velocity (Ciuffreda et al, 2017). These unexpected findings were confirmed in a retrospective study in 92 pediatric patients aged 7-17 years, which included those in all three phases of medically diagnosed injury combined (Hsu et al, 2021). There was some commonality in the two studies: average and maximum constriction velocities, and average dilation velocity, were significantly faster in the concussed individuals.…”

Combat Sports as a Model for Measuring the Effects of Repeated Head Impacts on Autonomic Brain Function: A Brief Report of Pilot Data

“…Dilation and constriction velocities all increased following sparring, though these were not found to be statistically relevant. Whilst these variables have been found to be faster in concussed children [ 40 ], they appear to become slower in concussed adults [ 27 ] with further decrements in velocity for each level of GCS severity [ 18 ]. As such, any potential acute brain dysfunction experienced by these participants appears to have been ‘minor’ according to our current understanding of PLR changes following trauma.…”

Do static and dynamic pupillary parameters differ according to childhood, adulthood, and old age? A quantitative study in healthy volunteers

“…Although the normative data on pupillary parameter values are not plentiful, they increase over time. Tekin et al ,[ 2 ] Shah et al ,[ 11 ] Brown et al ,[ 12 ] Crippa et al ,[ 25 ] Hsu et al ,[ 26 ] and Winston et al . [ 1 ] presented normative values in a healthy pediatric population.…”