Neurologist Versus Machine: Is the Pupillometer Better than the Naked Eye in Detecting Pupillary Reactivity
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A 62-year-old man with severe traumatic brain injury developed postsurgical anisocoria in which there was a discrepancy between pupillometer and manual testing.
The patient’s larger pupil was read as unreactive by the pupillometer but constricted 1 mm over 7–9 s of continuous light stimulation.
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.
KeywordsPupillometer Neurological examination Brain death Uncal herniation Neurocritical care Pupillary reactivity
Conflict of interest
Christopher Kramer, Sara Hocker, Alejandro Rabinstein, and Eelco Wijdicks declare that they have no conflict of interest.
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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