Objective Pupillometry as an Adjunct to Prediction and Assessment for Oculomotor Nerve Injury and Recovery: Potential for Practical Applications

Salah G. Aoun, Babu G. Welch, Michaela Cortes, Sonja E. Stutzman, Matthew C. MacAllister, Tarek Y. El Ahmadieh, Mohamed Osman, Stephen A. Figueroa, Jonathan A. White, Hunt H. Batjer, Daiwai M. Olson

Research output: Contribution to journalArticle

Abstract

Background: Pupillary light reflex examinations are intrinsic to any good neurological examination. Consistent evidence has shown that automated pupillometry assessments provide superior accuracy and interrater correlation compared with bedside eye examinations. Pupillary indexes such as the neurological pupil index (NPI) can also provide several hours of warning before the advent of herniation syndromes or third nerve palsy. Methods: We determined the unique temporal relationship between NPI changes and third nerve palsy occurrence and recovery in an initially neurologically intact hospitalized patient. A 53-year-old woman presented with aneurysmal subarachnoid hemorrhage and headaches. Her aneurysm was treated surgically without complications. After lumbar drainage for hydrocephalus, she developed isolated left third nerve palsy that slowly recovered over the following weeks. Pupilometer data were obtained throughout her hospital stay. Results: A total of 121 pupillary measurement sets were obtained. The NPI had decreased to an abnormal level (<3) 12 hours before she became symptomatic. The NPI also started improving 24 hours before improvement in her clinical examination. The patient did not display signs of neurological dysfunction related to vasospasm during her stay. Conclusion: The NPI seems to reliably correlate with third nerve function and appears to possess predictive temporal properties that could allow practitioners to anticipate neurological injury and recovery. These findings could affect the fields of neurosciences, trauma, military medicine, critical care, and ophthalmology.

Original languageEnglish (US)
JournalWorld Neurosurgery
DOIs
StateAccepted/In press - Jan 1 2018

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Oculomotor Nerve Injuries
Pupil
Oculomotor Nerve Diseases
Pupillary Reflex
Military Medicine
Wounds and Injuries
Neurologic Examination
Ophthalmology
Subarachnoid Hemorrhage
Critical Care
Hydrocephalus
Neurosciences
Aneurysm
Headache
Drainage
Length of Stay
Light

Keywords

  • Neurological assessment tool
  • Neurological pupil index
  • Objective pupillometry
  • Prognostic neurological tool
  • Pupillometer
  • Third nerve palsy recovery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Objective Pupillometry as an Adjunct to Prediction and Assessment for Oculomotor Nerve Injury and Recovery : Potential for Practical Applications. / Aoun, Salah G.; Welch, Babu G.; Cortes, Michaela; Stutzman, Sonja E.; MacAllister, Matthew C.; El Ahmadieh, Tarek Y.; Osman, Mohamed; Figueroa, Stephen A.; White, Jonathan A.; Batjer, Hunt H.; Olson, Daiwai M.

In: World Neurosurgery, 01.01.2018.

Research output: Contribution to journalArticle

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AU - Cortes, Michaela

AU - Stutzman, Sonja E.

AU - MacAllister, Matthew C.

AU - El Ahmadieh, Tarek Y.

AU - Osman, Mohamed

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AB - Background: Pupillary light reflex examinations are intrinsic to any good neurological examination. Consistent evidence has shown that automated pupillometry assessments provide superior accuracy and interrater correlation compared with bedside eye examinations. Pupillary indexes such as the neurological pupil index (NPI) can also provide several hours of warning before the advent of herniation syndromes or third nerve palsy. Methods: We determined the unique temporal relationship between NPI changes and third nerve palsy occurrence and recovery in an initially neurologically intact hospitalized patient. A 53-year-old woman presented with aneurysmal subarachnoid hemorrhage and headaches. Her aneurysm was treated surgically without complications. After lumbar drainage for hydrocephalus, she developed isolated left third nerve palsy that slowly recovered over the following weeks. Pupilometer data were obtained throughout her hospital stay. Results: A total of 121 pupillary measurement sets were obtained. The NPI had decreased to an abnormal level (<3) 12 hours before she became symptomatic. The NPI also started improving 24 hours before improvement in her clinical examination. The patient did not display signs of neurological dysfunction related to vasospasm during her stay. Conclusion: The NPI seems to reliably correlate with third nerve function and appears to possess predictive temporal properties that could allow practitioners to anticipate neurological injury and recovery. These findings could affect the fields of neurosciences, trauma, military medicine, critical care, and ophthalmology.

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