From the Guidelines
Pupillary examination is a crucial component of neurological assessment in cerebral stroke, providing valuable prognostic information and helping to predict patient outcomes.
Significance of Pupillary Examination
- Pupillary responses are strong predictors of outcome in brain-injured patients, including those with cerebral stroke 1.
- Automated pupillometry can objectively evaluate pupil size and reactivity, providing reliable prognostication information 1.
- A neurologic pupil index < 3 at any time 24–72 h after cannulation has 100% specificity for 90-day mortality, with 0% false positives 1.
Integration with Other Assessment Tools
- Pupillary responses can be integrated with the Glasgow Coma Scale (GCS) to provide greater specificity of outcome prediction 1.
- The FOUR score, which measures ocular and limb responses to command and pain, along with pupillary responses and respiratory pattern, may provide a more complete assessment of brainstem function 1.
Clinical Implications
- Pupillary examination can help identify patients at risk of poor outcomes, allowing for early intervention and management 1.
- High opiate doses may affect the reliability of pupillometry assessment, highlighting the need for careful consideration of medication effects on neurological assessment 1.
From the Research
Significance of Pupillary Examination in Cerebral Stroke
The pupillary examination is a crucial component of the neurological assessment in patients with cerebral stroke. The following points highlight its significance:
- Pupillary dysfunction is recognized as a sign of acute neurological deterioration due to worsening mass effect in patients with hemispheric strokes 2.
- Automated pupillometry has been shown to be more accurate and reliable than manual examination in measuring pupil size and reactivity 3, 4.
- The Neurological Pupil Index (NPi) and constriction velocity (CV) obtained with a hand-held pupilometer correlate with horizontal intracranial midline shift in patients with ischemic and hemorrhagic strokes 2.
- Abnormal pupillary function, assessed by the NPi, is associated with poor outcomes in patients with acute brain injury 5.
Clinical Utility of Automated Pupillometry
Automated pupillometry has several advantages over manual examination, including:
- Improved accuracy and reliability in measuring pupil size and reactivity 3, 4.
- Ability to detect subtle changes in pupillary function, which can be indicative of neurological deterioration 2, 5.
- Potential to provide earlier alert to potential brain damage in comatose patients 6.
- Can be implemented as an automated device for continuous pupillary monitoring, which may save staff resources 6.
Correlation with Neurological Outcomes
Studies have shown that pupillary examination, particularly using automated pupillometry, can provide valuable information about neurological outcomes in patients with cerebral stroke, including: