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Neurocritical Care

, Volume 21, Issue 2, pp 309–311 | Cite as

Neurologist Versus Machine: Is the Pupillometer Better than the Naked Eye in Detecting Pupillary Reactivity

  • Christopher L. KramerEmail author
  • Alejandro A. Rabinstein
  • Eelco F. M. Wijdicks
  • Sara E. Hocker
Practical Pearl

Abstract

Background

A 62-year-old man with severe traumatic brain injury developed postsurgical anisocoria in which there was a discrepancy between pupillometer and manual testing.

Methods

Case report.

Results

The patient’s larger pupil was read as unreactive by the pupillometer but constricted 1 mm over 7–9 s of continuous light stimulation.

Conclusions

While pupillometry assessment is a valuable adjunct to the manual pupillary assessment, this case demonstrates that nonreactive pupils read on the pupillometer should be confirmed with the manual examination because it can miss very slowly reacting pupils.

Keywords

Pupillometer Neurological examination Brain death Uncal herniation Neurocritical care Pupillary reactivity 

Notes

Conflict of interest

Christopher Kramer, Sara Hocker, Alejandro Rabinstein, and Eelco Wijdicks declare that they have no conflict of interest.

Supplementary material

Video: Pupillary reactivity assessment using the pupillometer and with manual testing. No reactivity is noted with pupillometer testing, however, slow reactivity was seen with a sustained light stimulus upon manual testing. Video specifications: Author: Christopher Kramer, M.D. Videographer: Elaine Flom, Sally Podein. Length: 23 s. Size: 43.3 MB (MP4 44364 kb)

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Christopher L. Kramer
    • 1
    Email author
  • Alejandro A. Rabinstein
    • 1
  • Eelco F. M. Wijdicks
    • 1
  • Sara E. Hocker
    • 1
  1. 1.Department of NeurologyMayo ClinicRochesterUSA

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