Fixed, Dilated, and Conversing-Unreactive Pupil With Preserved Consciousness Indicating Acutely Rising Intracranial Pressure due to Traumatic Intraparenchymal Contusions: Case Report and Review of the Literature.

Autor:	McAvoy M; Department of Neurological Surgery, University of Washington, Seattle, WA, USA., Lee G; Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA., Boop S; Department of Neurological Surgery, University of Washington, Seattle, WA, USA., Greil ME; Department of Neurological Surgery, University of Washington, Seattle, WA, USA., Durler KA; Department of Nursing, Harborview Medical Center, Seattle, WA, USA., Young CC; Department of Neurological Surgery, University of Washington, Seattle, WA, USA., Craft L; Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA., Chesnut RM; Department of Neurological Surgery, University of Washington, Seattle, WA, USA.; Department of Orthopedic Surgery, University of Washington, Seattle, WA, USA.; School of Global Health, University of Washington, Seattle, WA, USA., Wahlster S; Department of Neurological Surgery, University of Washington, Seattle, WA, USA.; Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.; Department of Neurology, University of Washington, Seattle, WA, USA.
Jazyk:	angličtina
Zdroj:	The Neurohospitalist [Neurohospitalist] 2022 Apr; Vol. 12 (2), pp. 355-360. Date of Electronic Publication: 2021 Dec 09.
DOI:	10.1177/19418744211056613
Abstrakt:	Patients with fixed and dilated pupils (FDPs) due to rising intracranial pressure (ICP) typically experience a deterioration in consciousness. We describe an exceptional case of a patient with bifrontal contusions who developed worsening edema and a unilaterally FDP while maintaining consciousness and the ability to communicate. A 58-year-old man with history of hypertension and diabetes mellitus type II presented after being assaulted, with bifrontal contusions and right frontal intraparenchymal hemorrhage. On hospital day 8, his right pupil became fixed (NPi 0) and dilated (4.8 mm). The patient was drowsy, arousable to tactile stimuli, answering questions, oriented to place and time, following commands on his right side, maintaining Glasgow Coma Scale of 14 (E4, V5, M6). He described complete loss of vision and could not identify objects or count fingers. His gaze was dysconjugate with impaired vertical excursion and inability to fully abduct to the right side. Corneal reflexes were intact bilaterally. Hypertonic saline and mannitol produced no improvement in his pupillary exam. Head computed tomography showed worsening midline shift and interval increase in subfalcine herniation related to increased peri-hematoma edema. We performed an emergent right-sided decompressive hemicraniectomy with durotomy and duraplasty. His pupil became reactive 5 hours after surgery. While FDP without deterioration of consciousness has been described due to traumatic subdural and epidural hematomas, we report this unusual constellation as a sign of rising ICP and impeding herniation due to intraparenchymal contusions, highlighting that any pupillary change warrants prompt work-up and intervention. Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. (© The Author(s) 2021.)
Databáze:	MEDLINE
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