![]() ![]() ![]() One of the most feared and devastating complications of carotid revascularization procedures is hyperperfusion hemorrhage. This review discusses the differential diagnosis of a large pupil (anisocoria more obvious in the light) and a small pupil (anisocoria more obvious in the dark), and discusses the relevant afferent pupillary defect, in which there is no anisocoria but both pupils react differently depending on which eye is illuminated. The aim is to provide clinicians with confidence when encountering patients with anisocoria.Īnisocoria can imply serious underlying pathology, so accurate pupil testing and astute observation are paramount. ![]() This review examines the anatomy of the pupillary pathway, and provides a structured approach to examination Examination of the pupils is therefore a crucial part of any eye examination.Īs a clinician, it is important to determine whether a patient with anisocoria can be reassured or requires referral for further investigation. Importantly, anisocoria can indicate underlying disease of the eye, orbit, brain, neck or chest. Conclusion : Although the two researchers found near perfect agreement in pupil size, symmetry, and reactivity assessment, two researchers and the nurse found moderate agreement in pupil symmetry and fair-to-good agreement in pre- and post-light stimulation pupil size.īe physiological, pathological or pharmacological. Agreement in pupil symmetry was moderated (K = 0.58), and reactivity was near perfect (K = 0.89) between the three In patients with pupil size ≥4 mm, the observers found fair-to-good agreements in both right and left pupil initial size measurements (ICC = 0.52 ICC = 0.65). Results : Three observers -–two researchers and the nurse- – found fair-to-good and excellent agreements in initial pupil size evaluations of right and left pupils, respectively (ICC = 0.70, 95% ICC = 0.75, 9). A total of 200 pupillary measurement sets were completed independently and blindly. Methods : In this prospective, blinded, and observational study, ICU nurses and two researchers evaluated the pupil size, reactivity, and symmetry of 200 patients with neurosurgery or neurological diseases. Reliable pupil assessment is a vital evaluation in diagnostic and therapeutic procedures for neurocritical patients.Īim : To evaluate inter-rater reliability of pupillary assessment among ICU nurses. GCS at admission can predict mortality, but it is not a significant predictor of long term outcome among survivors.īackground : Pupillary abnormalities are a common and reliable finding of brain herniation, ischemia, and acute brain injuries in ICU patients. Secondary systemic insults negatively affect outcome. Conclusion: Head injury is commonest in 8-12 years age group, RTA being the commonest etiology, and mild injuries being the commonest type. 49% had good outcome with low disability (Glasgow outcome score 5) and 7.2% had post-traumatic seizure disorder. Multivariate analysis showed that moderate and severe head injury, hyponatremia, nosocomial infections and presence of midline shift in CT brain were the independent risk factors for development of poor outcome. Univariate analysis showed need for mechanical ventilation, anisocoria, SSIs, and low Glasgow Coma Scale scores to be the strongest predictors of mortality (p values<0.0001). Mortality was 20%, brain herniation being the leading cause. Neurosurgical procedures were needed in 25% cases. 50% patients developed secondary systemic insults (SSIs). Results: Among 220 patients, 53.2%, 30.9% and15.9% suffered mild, moderate and severe head injury. Odds ratios and risk ratios were estimated with their 95% confidence intervals (95%CI). Risk factors were evaluated by multivariate analysis by a multiple logistic stepwise regression procedure. Continuous variable were evaluated by Student's t-test. Categorized data were analyzed by Chi-square test. They were followed up on outpatient basis for 1 year. Methods: In this retrospective, bi-centric study on clinico-epidemiological profile, outcome and prognostic factors of traumatic brain injury in pediatric patients, all the case records of 220 children aged <12 years were reviewed and pertinent data (basic demographic, clinical, biochemical, and radiological data on admission and during ICU stay) were collected. Introduction: Traumatic brain injury (TBI) in infancy and childhood is documented as the single most common cause of death and also leads to functional disability and psychosocial maladjustments in the survivors.
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