Anisocoria and Poor Pupil Reactivity by Quantitative Pupillometry in Patients With Intracranial Pathology
| Autor: | Sahar F. Zafar, Brenton Prescott, Josée Dupuis, David M. Greer, Charlene Ong, Matthew I. Miller, Hanife Saglam, Arnav S Thakur, Stelios M. Smirnakis, Emelia J. Benjamin, Meghan R Hutch, Jonathan A. Duskin, Eesha A Gholap |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty genetic structures Reflex Pupillary Critical Care and Intensive Care Medicine Logistic regression Article Pupil Cohort Studies Midline shift Ophthalmology medicine Humans Reactivity (psychology) Retrospective Studies Subclinical infection Anisocoria business.industry Brain Odds ratio Middle Aged eye diseases Intensive Care Units Female sense organs medicine.symptom business Pupillometry |
| Zdroj: | Crit Care Med |
| ISSN: | 0090-3493 |
| Popis: | Objectives To describe the prevalence and associated risk factors of new onset anisocoria (new pupil size difference of at least 1 mm) and its subtypes: new onset anisocoria accompanied by abnormal and normal pupil reactivities in patients with acute neurologic injuries. Design We tested the association of patients who experienced new onset anisocoria subtypes with degree of midline shift using linear regression. We further explored differences between quantitative pupil characteristics associated with first-time new onset anisocoria and nonnew onset anisocoria at preceding observations using mixed effects logistic regression, adjusting for possible confounders. Setting All quantitative pupil observations were collected at two neuro-ICUs by nursing staff as standard of care. Patients We conducted a retrospective two-center study of adult patients with intracranial pathology in the ICU with at least a 24-hour stay and three or more quantitative pupil measurements between 2016 and 2018. Measurements and main results We studied 221 patients (mean age 58, 41% women). Sixty-three percent experienced new onset anisocoria. New onset anisocoria accompanied by objective evidence of abnormal pupil reactivity occurring at any point during hospitalization was significantly associated with maximum midline shift (β = 2.27 per mm; p = 0.01). The occurrence of new onset anisocoria accompanied by objective evidence of normal pupil reactivity was inversely associated with death (odds ratio, 0.34; 95% CI, 0.16-0.71; p = 0.01) in adjusted analyses. Subclinical continuous pupil size difference distinguished first-time new onset anisocoria from nonnew onset anisocoria in up to four preceding pupil observations (or up to 8 hr prior). Minimum pupil reactivity between eyes also distinguished new onset anisocoria accompanied by objective evidence of abnormal pupil reactivity from new onset anisocoria accompanied by objective evidence of normal pupil reactivity prior to first-time new onset anisocoria occurrence. Conclusions New onset anisocoria occurs in over 60% of patients with neurologic emergencies. Pupil reactivity may be an important distinguishing characteristic of clinically relevant new onset anisocoria phenotypes. New onset anisocoria accompanied by objective evidence of abnormal pupil reactivity was associated with midline shift, and new onset anisocoria accompanied by objective evidence of normal pupil reactivity had an inverse relationship with death. Distinct quantitative pupil characteristics precede new onset anisocoria occurrence and may allow for earlier prediction of neurologic decline. Further work is needed to determine whether quantitative pupillometry sensitively/specifically predicts clinically relevant anisocoria, enabling possible earlier treatments. |
| Databáze: | OpenAIRE |
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