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

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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.

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Conflict of interest

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

Author information

Authors and Affiliations

  1. Department of Neurology, Mayo Clinic, Mary Brigh 8-D, 200 First Street SW, Rochester, MN, 55905, USA

    Christopher L. Kramer, Alejandro A. Rabinstein, Eelco F. M. Wijdicks & Sara E. Hocker

Authors
  1. Christopher L. Kramer
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  2. Alejandro A. Rabinstein
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  3. Eelco F. M. Wijdicks
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  4. Sara E. Hocker
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Corresponding author

Correspondence to Christopher L. Kramer.

Additional information

All aspects of this study were conducted at the Mayo Clinic Rochester, MN without any financial support.

Electronic supplementary material

Below is the link to the electronic 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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Kramer, C.L., Rabinstein, A.A., Wijdicks, E.F.M. et al. Neurologist Versus Machine: Is the Pupillometer Better than the Naked Eye in Detecting Pupillary Reactivity. Neurocrit Care 21, 309–311 (2014). https://doi.org/10.1007/s12028-014-9988-5

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  • DOI: https://doi.org/10.1007/s12028-014-9988-5

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