Pitfall in Pupillometry: Exaggerated Ciliospinal Reflex in a Patient in Barbiturate Coma Mimicking a Nonreactive Pupil

Mullaguri, Naresh; Katyal, Nakul; Sarwal, Aarti; Beary, Jonathan M.; George, Pravin; Karthikeyan, Naresh; Nattanamai, Premkumar; Newey, Christopher R.

doi:10.7759/cureus.2004

Cited by 6 publications

(8 citation statements)

References 5 publications

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“…Brain death refers to the irreversible stop of whole brain function due to persistent and severe cerebral ischemia, hypoxia or other reasons (Tang et al, 2019). The diagnosis of brain death requires comprehensive clinical conditions and a variety of examination methods (Mullaguri et al, 2018). At present, there are a variety of detection methods to help confirm brain death, including radionuclide scanning, cerebral angiography and so on.…”

Section: Discussionmentioning

confidence: 99%

Non-invasive Evaluation of Brain Death Caused by Traumatic Brain Injury by Ultrasound Imaging

Niu

Tang

Hao

et al. 2020

Front. Neuroinform.

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Objectives To investigate the clinical value of non-invasive ultrasound imaging in the evaluation of brain death caused by traumatic brain injury. Methods Thirty-four patients with acute severe traumatic brain injury were admitted to hospital within 48 h after injury. All patients were monitored intracranial pressure, transcranial Doppler, echocardiography examination, collection intracranial pressure, MCA-Vs, MCA-Vd, MCA-Vm, EF, LVMPI, RVMPI and other indicators, and combined with clinical conditions and other related data for comparative study and statistical analysis. Results The blood flow spectrum was characterized by diastolic retrograde blood flow spectrum pattern and nail waveform spectrum shape when the patient had clinical brain death. For the parameters of transcranial Doppler, there were significant differences in MCA-Vm and PI between clinical brain death group and normal control group ( P < 0.05). For the parameters of echocardiography, there were statistically significant differences in EF, LVMPI, and RVMPI between clinical brain death group and normal control group ( P < 0.05). Conclusion Non-invasive dynamic monitoring of cerebral hemodynamics and cardiac function parameters in patients with severe craniocerebral injury can provide a high accuracy and reliability for the preliminary diagnosis of brain death in patients with severe craniocerebral injury. It is helpful for early evaluation of prognosis and provides effective monitoring methods and guidance for clinical treatment.

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Section: Discussionmentioning

confidence: 99%

Non-invasive Evaluation of Brain Death Caused by Traumatic Brain Injury by Ultrasound Imaging

Niu

Tang

Hao

et al. 2020

Front. Neuroinform.

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“…41,42 This phenomena has been confirmed by pupillometry. 43 These studies show that high-dose barbiturates can mimic the effects of high ICP on quantitative pupillometry, and recognizing this may prevent unneeded intervention.…”

Section: Medication Effects On the Plrmentioning

confidence: 95%

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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“…Fifty-four (53%) patients were admitted after out-of-hospital CA, seventy-one (71%) had a witnessed CA and 68% received bystander-initiated resuscitation. Twenty-two (22%) patients had a shockable rhythm and the median time to return of spontaneous circulation was 20 [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] min. ICU mortality occurred in 60 (59%) patients, while 69 (68%) patients had UO.…”

Section: Study Populationmentioning

confidence: 99%

Pain pupillary index to prognosticate outcome in comatose cardiac arrest patients

Macchini

Bertelli

Bogossian

et al. 2022

Preprint

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Background: The Neurologic Pupil Index (NPi), derived from automated pupillometry, can accurately predict poor neurological outcome in post-anoxic brain injury. The prognostic role of another index, called Pupillary Pain Index (PPI), remains unknown in this setting. Methods: Monocentric study in adult comatose cardiac arrest (CA) patients. Quantitative PPI and NPi were concomitantly recorded on day 1 and day 2 after CA. The primary study outcome was to assess the prognostic value of PPI to predict 3-month unfavourable outcome (UO, defined as Cerebral Performance Category of 3–5). Secondary outcome was the agreement between PPI and NPi to predict unfavourable outcome. Results: A total of 102 patients were included; 69 patients (68%) patients had UO. Patients with UO showed a lower NPi (4.2 [3.5-4.5] vs. 4.6 [4.3-4.7]; p<0.01 on day 1 - 4.3 [3.8-4.7] vs 4.6 [4.3-4.8] on day 2), and PPI (3 [1-6] vs. 6 [3-7]; p<0.01 on day 1 - 3 [1-6] vs 6 [4-8]; p<0.01 on day 2) than others. PPI and NPi had similar predictive accuracy on day 1 and day 2 for UO. A PPI=1 on day 2 showed a sensitivity of 26 [95% CI 16-38]%, a specificity of 100 [95% CI 89-100]%, a NPV of 39 [95% CI 36-43]% and a PPV of 100% [95% CI 100-100]% to predict UO. On day 2, a total of 6 patients had concomitant PPI=1 and NPi ≤2, while 12 showed NPi>2 and PPI=1; the coefficient of agreement was 0.42. Moreover, NPi and PPI values showed a moderate correlation both on day 1 and day 2. Conclusions: In this study, PPI=1 on day 2 could accurately predict UO in comatose CA patients, with 100% specificity and a higher sensitivity than NPi. The agreement between PPI and NPi values was moderate.

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Pitfall in Pupillometry: Exaggerated Ciliospinal Reflex in a Patient in Barbiturate Coma Mimicking a Nonreactive Pupil

Cited by 6 publications

References 5 publications

Non-invasive Evaluation of Brain Death Caused by Traumatic Brain Injury by Ultrasound Imaging

Non-invasive Evaluation of Brain Death Caused by Traumatic Brain Injury by Ultrasound Imaging

Quantitative Pupillometry in the Intensive Care Unit

Pain pupillary index to prognosticate outcome in comatose cardiac arrest patients

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