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pupillary reactivity

Marta Cicuendez, Ana Castaño-León, Ana Ramos, Amaya Hilario, Pedro A Gómez, Alfonso Lagares
BACKGROUND: This study was performed to investigate the relationship between corpus callosum (CC) injury and prognosis in traumatic axonal injury (TAI). METHOD: We retrospectively reviewed 264 patients with severe head trauma who underwent a conventional MR imaging in the first 60 days after injury. They were selected from a prospectively collected database of 1048 patients with severe head trauma admitted in our hospital. TAI lesions were defined as areas of increased signal intensity on T2 and FLAIR or areas of decreased signal on gradient-echo T2...
October 31, 2016: Acta Neurochirurgica
Susanne Muehlschlegel, Didem Ayturk, Aditi Ahlawat, Saef Izzy, Thomas M Scalea, Deborah M Stein, Timothy Emhoff, Kevin N Sheth
OBJECTIVE: To identify predictors associated with survival in civilian penetrating traumatic brain injury (pTBI) utilizing a contemporary, large, diverse 2-center cohort, and to develop a parsimonious survival prediction score for pTBI. METHODS: Our cohort comprised 413 pTBI patients retrospectively identified from the local trauma registries at 2 US level 1 trauma centers, of which one was predominantly urban and the other predominantly rural. Predictors of in-hospital and 6-month survival identified in univariate and multivariable logistic regression were used to develop the simple Surviving Penetrating Injury to the Brain (SPIN) score...
November 22, 2016: Neurology
Lori N Scott, Maureen Zalewski, Joseph E Beeney, Neil P Jones, Stephanie D Stepp
Etiological models propose that a biological vulnerability to emotional reactivity plays an important role in the development of borderline personality disorder (BPD). However, the physiological and phenomenological components of emotional reactivity that predict the course of BPD symptoms in adolescence are poorly understood. This prospective study examines pupillary and affective responses to maternal feedback as predictors of BPD symptom development in adolescent girls over 18 months. Fifty-seven 16-year-old girls completed a laboratory task in which they heard recorded clips of their own mothers making critical or praising statements about them, as well as neutral statements that did not pertain to them...
October 25, 2016: Development and Psychopathology
Patrick Gomez, Armin von Gunten, Brigitta Danuser
In the present study, we examined how sex and age shape cardiovascular, electrodermal, and pupillary reactivity to picture series within the valence-arousal affective space in a sample of 176 healthy younger, middle-aged, and older men and women. Across participants, heart rate (HR) decelerated with increasing self-reported unpleasantness, whereas skin conductance level (SCL) and pupil size (PS) increased with increasing self-rated arousal. Systolic (SBP) and diastolic (DBP) blood pressure increased with increasing self-rated arousal when valence was pleasant but much less when valence was unpleasant...
November 2016: International Journal of Psychophysiology
Anastacia Y Kudinova, Katie L Burkhouse, Greg Siegle, Max Owens, Mary L Woody, Brandon E Gibb
There is a large body of research supporting the association between disrupted physiological reactivity to negative stimuli and depression. The present study aimed to examine whether physiological reactivity to emotional stimuli, assessed via pupil dilation, served as a biological marker of risk for depression recurrence among individuals who are known to be at a higher risk due to having previous history of depression. Participants were 57 women with a history of major depressive disorder (MDD). Pupil dilation to angry, happy, sad, and neutral faces was recorded...
December 2016: Psychophysiology
Margarita G Todorova, Cameron F Parsa
BACKGROUND: Variable pupillary responses have been described with carotid-cavernous sinus fistulas. These often are associated with a decrease in visual acuity and attributed to retinal ischemia. We propose a novel pathophysiologic mechanism for changes in pupillary reactivity involving anatomic changes secondary to choroidal effusion. METHODS: To demonstrate proof-of-concept, we investigated 2 consecutive patients with carotid-cavernous sinus fistulas and pupillary disturbances using repeated refractions and anterior segment ultrasound biomicroscopy...
September 22, 2016: Journal of Neuro-ophthalmology: the Official Journal of the North American Neuro-Ophthalmology Society
Sandro Rizoli, Ashley Petersen, Eileen Bulger, Raul Coimbra, Jeffrey D Kerby, Joseph Minei, Laurie Morrison, Avery Nathens, Martin Schreiber, Airton Leonardo de Oliveira Manoel
BACKGROUND: Traumatic brain injury (TBI) is a heterogeneous syndrome with a broad range of outcome. We developed a simple model for long-term outcome prognostication after severe TBI. METHODS: Secondary data analysis of a large multicenter randomized trial. Patients were grouped according to 6-month extended Glasgow outcome scale (eGOS): poor-outcome (eGOS ≤ 4; severe disability or death) and acceptable outcome (eGOS > 4; no or moderate disability)...
August 24, 2016: BMC Emergency Medicine
Weidan Zhao, Sonja Stutzman, Olson DaiWai, Ciji Saju, Margaret Wilson, Venkatesh Aiyagari
The purpose of this study was to explore the inter-device reliability of NPi-100 pupillometers (NeuroOptics, Inc.). The pupillary examination is a fundamental element of the neurological exam. Current evidence suggests that the traditional examination of the pupil with a hand held flashlight has limited inter-rater reliability. Automated pupillometers were developed to provide an objective scoring of pupil size and reactivity. However, there are no data examining inter-device reliability of automated pupil assessments...
July 12, 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Dimitris Papaconstantinou, George Kalantzis, Dimitris Brouzas, Anastasios Kontaxakis, Chryssanthi Koutsandrea, Andreas Diagourtas, Ilias Georgalas
PURPOSE: The aim of this study was to compare the results of phacoemulsification through a small pupil using minimal iris manipulation versus phacoemulsification through a well-dilated pupil. METHODS: This prospective randomized control (comparative) study comprised 78 patients (group I) with a maximally dilated pupil size of ≤4.00 mm and 45 patients (group II) with dilated pupil size of ≥7.00 mm. In group I patients, only viscodilation and minimal push-and-pull iris stretching with two collar-button iris-retractor hooks were utilized without iris manipulation...
2016: Clinical Interventions in Aging
Laxmi P Dhakal, Ayan Sen, Carlene M Stanko, Bhupendra Rawal, Michael G Heckman, Jonathan B Hoyne, Elliot L Dimberg, Michelle L Freeman, Lauren K Ng, Alejandro A Rabinstein, William D Freeman
Loss of pupillary light reactivity is one recognized indicator of poor prognosis after cardiopulmonary resuscitation (CPR). However, drug overdose, low cardiac output, and/or resuscitation drugs can lead to impaired pupillary light reflex. To investigate pupillary light reflex status before therapeutic hypothermia (TH) in relation to neurological outcome, we retrospectively reviewed the data of a prospectively implemented TH protocol in patients with cardiac arrest (CA) at Mayo Clinic in Jacksonville, Florida (January 2006-January 2012), and Mayo Clinic in Scottsdale, Arizona (August 2010-March 2014)...
August 2016: Therapeutic Hypothermia and Temperature Management
Robert G Kerr, Andrea M Bacon, Laura L Baker, Janelle S Gehrke, K Danielle Hahn, Cheryl L Lillegraven, Catherine Hackett Renner, Sarah K Spilman
BACKGROUND: Early detection of pupillary changes in patients with head injuries can alert the care team to increasing intracranial pressure. Previous research has shown inconsistencies in pupil measurement that are most likely due to the subjective nature of measuring pupils without the assistance of technology. OBJECTIVES: To evaluate nurses' abilities to assess pupil diameter accurately and detect unequal pupils. METHODS: In a 3-part study, the accuracy of critical care and neurosurgical nurses' assessments of pupils was determined...
May 2016: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
David Couret, Delphine Boumaza, Coline Grisotto, Thibaut Triglia, Lionel Pellegrini, Philippe Ocquidant, Nicolas J Bruder, Lionel J Velly
BACKGROUND: In critical care units, pupil examination is an important clinical parameter for patient monitoring. Current practice is to use a penlight to observe the pupillary light reflex. The result seems to be a subjective measurement, with low precision and reproducibility. Several quantitative pupillometer devices are now available, although their use is primarily restricted to the research setting. To assess whether adoption of these technologies would benefit the clinic, we compared automated quantitative pupillometry with the standard clinical pupillary examination currently used for brain-injured patients...
2016: Critical Care: the Official Journal of the Critical Care Forum
Jason M Matuszak, Jennifer McVige, Jacob McPherson, Barry Willer, John Leddy
CONTEXT: With heightened awareness of concussion, there is a need to assess and manage the concussed patient in a consistent manner. Unfortunately, concussion physical examination has not been standardized or supported by evidence. Important questions remain about the physical examination. EVIDENCE ACQUISITION: Review of ClinicalKey, Cochrane, MEDLINE, and PubMed prior to July 2015 was performed using search terms, including concussion, mTBI, physical examination, mental status, cranial nerves, reflexes, cervical, vestibular, and oculomotor...
March 28, 2016: Sports Health
Vineet Kumar Kamal, Deepak Agrawal, Ravindra Mohan Pandey
OBJECTIVE: To identify the best performing prognostic model using admission characteristics to predict mortality at 30 days and functioning outcome at 6-months post-admission in patients with moderate or severe brain injury. METHODS: Using a retrospective database (n = 1466 patients) of a tertiary trauma care centre, three different models were developed using logistic regression methods for predicting mortality and functioning outcome. The performance of the models was assessed in terms of discrimination and calibration...
March 22, 2016: Brain Injury: [BI]
Tjeerd van der Ploeg, Daan Nieboer, Ewout W Steyerberg
BACKGROUND AND OBJECTIVE: Prediction of medical outcomes may potentially benefit from using modern statistical modeling techniques. We aimed to externally validate modeling strategies for prediction of 6-month mortality of patients suffering from traumatic brain injury (TBI) with predictor sets of increasing complexity. METHODS: We analyzed individual patient data from 15 different studies including 11,026 TBI patients. We consecutively considered a core set of predictors (age, motor score, and pupillary reactivity), an extended set with computed tomography scan characteristics, and a further extension with two laboratory measurements (glucose and hemoglobin)...
March 14, 2016: Journal of Clinical Epidemiology
Phillip D Fletcher, Jennifer M Nicholas, Laura E Downey, Hannah L Golden, Camilla N Clark, Carolina Pires, Jennifer L Agustus, Catherine J Mummery, Jonathan M Schott, Jonathan D Rohrer, Sebastian J Crutch, Jason D Warren
The meaning of sensory objects is often behaviourally and biologically salient and decoding of semantic salience is potentially vulnerable in dementia. However, it remains unclear how sensory semantic processing is linked to physiological mechanisms for coding object salience and how that linkage is affected by neurodegenerative diseases. Here we addressed this issue using the paradigm of complex sounds. We used pupillometry to compare physiological responses to real versus synthetic nonverbal sounds in patients with canonical dementia syndromes (behavioural variant frontotemporal dementia - bvFTD, semantic dementia - SD; progressive nonfluent aphasia - PNFA; typical Alzheimer's disease - AD) relative to healthy older individuals...
April 2016: Cortex; a Journal Devoted to the Study of the Nervous System and Behavior
Giancarlo A Garcia, Philip Ngai, Swapna Vemuri, Jeremiah P Tao
PURPOSE: Adrenergic medications may elevate the upper eyelid and dilate the pupil. The effects of topical phenylephrine on Müller's muscle have been well described. Dilute epinephrine (DE) is a sympathomimetic agent commonly administered in blepharoptosis surgery, and has been shown to elevate the upper eyelid margin when injected subcutaneously. The effects of DE applied topically to the eye, whether intentional or inadvertent during surgery have not been characterized. The purpose of this investigation was to quantify and compare the effects of topical DE and phenylephrine on upper eyelid position and pupil size...
February 12, 2016: Ophthalmic Plastic and Reconstructive Surgery
Kazuhiro Shirozu, Hidekazu Setoguchi, Kentaro Tokuda, Yuji Karashima, Mizuko Ikeda, Makoto Kubo, Katsuya Nakamura, Sumio Hoka
Pupil reactivity can be used to evaluate central nervous system function and can be measured using a quantitative pupillometer. However, whether anesthetic agents affect the accuracy of the technique remains unclear. We examined the effects of anesthetic agents on pupillary reactivity. Thirty-five patients scheduled for breast or thyroid surgery were enrolled in the study. Patients were divided into four groups based on the technique used to maintain anesthesia: a sevoflurane-remifentanil (SEV/REM) group, a sevoflurane (SEV) group, a desflurane-remifentanil (DES/REM) group, and a propofol-remifentanil (PRO/REM) group...
February 8, 2016: Journal of Clinical Monitoring and Computing
Trung Q Ho, Daniel Jupiter, Jonathan H Tsai, Marcin Czerwinski
BACKGROUND: Prompt identification of significant ocular injuries in patients who sustain an orbital fracture is important to prevent any potential long-term visual sequelae. The true incidence of these injuries has not been determined, however. As a consequence, most surgeons choose to have all patients evaluated by an ophthalmologist. The objective of this study was to conclusively identify the incidence of significant ocular injuries in patients with isolated orbital fractures and to determine their predictors to guide more efficient patient care...
January 30, 2016: Annals of Plastic Surgery
Xiao-Gang Kang, Feng Yang, Wen Li, Chen Ma, Li Li, Wen Jiang
BACKGROUND: A reliable predictor for early recovery of consciousness in comatose patients is of great clinical significance. Here we aimed to investigate the potentially prognostic value of electroencephalogram-reactivity (EEG-R) in combination with sleep spindles, termed EEG-awakening, for behavioral awakening in etiologically diverse comatose patients. METHODS: We performed a prospectively observational study on a sample of patients, all of whom were in coma lasting longer than 3 days...
December 2015: Annals of Intensive Care
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