In addition, visual assessment of the practitioners can be affected by ambient light conditions, which impact the inter-examiner agreement. However, these terms are subjective as they lack the standard clinical definition and this leads to poor validity and reliability of the neurologic assessment ( 8–11). With this method, specific terminology is employed to describe the PLR and that includes brisk, sluggish, or nonreactive ( 7). Assessment of the PLR in patients with neurologic conditions has been performed using a penlight ( 1–3). Impaired PLR is related to conditions that may cause increased risk of central brain herniation or horizontal shift of the intracranial tissues ( 6). BACKGROUNDĮxamination of the functional status of the optic nerve (cranial nerve -II) and oculomotor nerve (CN-III) can be performed through the PLR assessment. Having developed a registry ( 5) of automated pupillometer data that includes over 3,000 subjects, this study aimed to replicate the study by McNett et al ( 4) with a larger sample set that includes subject data from three different institutions. These results suggest that elevated ICP may be manifest in the PLR as decreased neurologic pupil index (NPi) and constriction velocity (CV), without significant change in pupil size. A recent study by McNett et al ( 4) explored associations between measures of PLR and intracranial pressure (ICP). Increased use of this technology has led to more research. The traditional pupillary assessment performed using a penlight is being gradually replaced with automated pupilometer assessments ( 1–3). Our findings confirm and extend those of McNett et al Worsening measures of the pupillary light reflex using automated pupillometry are associated with elevated intracranial pressure.Įxamination of the pupillary light reflex (PLR) is essential to a comprehensive neurologic assessment. In the setting of increased intracranial pressure, mean pupilometer values were lower for both left and right eyes comparing to normal intracranial pressure, except right neurologic pupil index (3.98, 3.92 p = 0.0300) and left latency (0.27, 0.25 p < 0.0001). Analysis of t-test indicates statistically significant differences for all right and left mean pupilometer values, except right latency ( p = 0.3000) and repeated measure mixed model ( p = 0.0001). To evaluate findings by the previous author, we explored for differences among measures of the pulmonary light reflex obtained from automated pupillometry with ICP values dichotomized as < 15 mm Hg (normal) versus ≥ 15 mm Hg (elevated). Within the Establishing Normative Data for Pupillometer Assessments in Neuroscience Intensive Care registry there were 273 patients (16,221 pupillary observations) that included both intracranial pressure and pupillometry values. In a diverse, multicenter population, to confirm or refute the conclusions that pupillary light reflex changes are associated with increased intracranial pressure. The work cannot be changed in any way or used commercially without permission from the journal. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. Supported, in part, by grants from NeurOptics.įor information regarding this article, E-mail: Al-Obaidi has disclosed that he does not have any potential conflicts of interest. Atem, Stutzman, and Olson received salary support from NeurOptics for the research study. Olson contributed in investigation, conceptualization, writing original draft, supervision, and funding acquisition.ĭrs. Stutzman contributed in resources, writing original draft, and project administration. Atem contributed in conceptualization, formal analysis, data curation, supervision, methodology, writing review, and editing. Al-Obaidi contributed in conceptualization, formal analysis, data curation, and writing original draft. This work was performed at the University of Texas Southwestern Medical Center, Dallas, TX. 1School of Medicine, University of Texas Southwestern, Dallas, TX.ĢDepartment of Biostatistics and Data Science, University of Texas at Houston, Houston, TX.ģDepartment of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX.ĤDepartment of Neurological Surgery, University of Texas Southwestern, Dallas, TX.
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