دورية أكاديمية
Automated Pupillometry and Detection of Clinical Transtentorial Brain Herniation: A Case Series.
| العنوان: | Automated Pupillometry and Detection of Clinical Transtentorial Brain Herniation: A Case Series. |
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| المؤلفون: | Papangelou A; Department of Anesthesiology, Emory University Hospital, 1364 Clifton Road NE, Atlanta GA 30322., Zink EK; The Johns Hopkins Hospital Department of Neuroscience Nursing, 600N Wolfe Street, Baltimore MD 21287., Chang WW; Department of Neurology, University of Maryland Medical Systems, 22S Greene Street, G7K55, Baltimore MD 21201.; Department of Emergency Medicine, University of Maryland Medical Systems, 22S Greene Street, G7K55, Baltimore MD 21201., Frattalone A; Department of Neurology, San Antonio Military Medical, Center, 3551 Roger Brooke Drive, San Antonio TX 78219.; Department of Trauma Critical Care, San Antonio Military Medical Center, 3551 Roger Brooke Drive, San Antonio TX 78219., Gergen D; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 600N Wolfe Street, Baltimore MD 21287., Gottschalk A; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 600N Wolfe Street, Baltimore MD 21287.; Department of Neurosurgery, Johns Hopkins University School of Medicine, 600N Wolfe Street, Baltimore MD 21287., Geocadin RG; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 600N Wolfe Street, Baltimore MD 21287.; Department of Neurosurgery, Johns Hopkins University School of Medicine, 600N Wolfe Street, Baltimore MD 21287.; Department of Neurology, Johns Hopkins University School of Medicine, 600N Wolfe Street, Baltimore MD 21287. |
| المصدر: | Military medicine [Mil Med] 2018 Jan 01; Vol. 183 (1-2), pp. e113-e121. |
| نوع المنشور: | Journal Article; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Oxford University Press Country of Publication: England NLM ID: 2984771R Publication Model: Print Cited Medium: Internet ISSN: 1930-613X (Electronic) Linking ISSN: 00264075 NLM ISO Abbreviation: Mil Med Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2018- : Oxford : Oxford University Press Original Publication: Washington, D.C. : Association of Military Surgeons, United States, 1955- |
| مواضيع طبية MeSH: | Encephalocele/*diagnosis , Pupil/*physiology, Adult ; Female ; Humans ; Intensive Care Units/organization & administration ; Intensive Care Units/statistics & numerical data ; Intracranial Pressure/physiology ; Male ; Reflex, Pupillary/physiology |
| مستخلص: | Introduction: Transtentorial herniation (TTH) is a life-threatening neurologic condition that typically results from expansion of supratentorial mass lesions. A change in bedside pupillary examination is central to the clinical diagnosis of TTH. Materials and. Methods: To quantify the changes in the pupillary examination that precede and accompany TTH and its treatment, we evaluated 12 episodes of herniation in three patients with supratentorial mass lesions using automated pupillometry (NeurOptics, Inc., Irvine, CA). Herniation was defined clinically by the onset of fixed and dilated pupils in association with decreased levels of consciousness. Automated pupillometry was measured simultaneously with the bedside clinical examination, but the clinical team was blinded to these results and could not act on the data. Data from the pupillometer were downloaded 1-2 times per week onto a secured laptop, and data processing was facilitated by the use of Mathematica 8.0. Results: Neurologic Pupil Index measurements, values generated by the pupillometer based on an algorithm that incorporates pupillary size and reactivity in a normal population, were found to be abnormal before 73% of TTHs. This abnormality occurred at a median of 7.4 h before TTH. All episodes of TTH were reversed after clinical intervention at a median of 43 min after the event. The value did not fall to 0 in 42% of clinical herniations, but it did decrease to very abnormal values of 0.5-0.8. Conclusions: The potential of automated pupillometry to guide the management of severely injured neurologic patients is intriguing and warrants further study in the critical care unit and beyond. The utility of a portable device in the combat setting may allow for triage of patients with severe neurologic injury. (© Association of Military Surgeons of the United States 2018. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.) |
| فهرسة مساهمة: | Keywords: Automated pupillometry; Central herniation; Herniation; Intracranial hypertension; Intracranial pressure; Kernohan’s notch; Neurologic Pupil Index; Pupillometer; Transtentorial herniation |
| تواريخ الأحداث: | Date Created: 20180110 Date Completed: 20190322 Latest Revision: 20190322 |
| رمز التحديث: | 20240628 |
| DOI: | 10.1093/milmed/usx018 |
| PMID: | 29315412 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1930-613X |
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| DOI: | 10.1093/milmed/usx018 |