Pupillary Light Reflex Variability as a Predictor of Clinical Outcomes in Subarachnoid Hemorrhage

BACKGROUND: A change in the pupillary light reflex (PLR) is a sensitive indicator for detecting expanding intracranial lesions. Changes in PLR may be a prognostic marker for patients with intracranial lesions. The purpose of this analysis was to explore how PLR readings, size, constriction velocity (CV), dilation velocity (DV), Neurologic Pupil Index (NPi), and latency predict clinical outcome in patients with subarachnoid hemorrhage. METHODS: This is a secondary analysis of prospectively collected multicenter registry data. The within-subject standard deviation (WSD) of PLR values, NPi, size, CV, DV, and latency were explored as predictors of discharge modified Rankin Scale (mRS) in patients with subarachnoid hemorrhagic. RESULTS: Among 4403 pupillary readings from 82 patients with a diagnosis of subarachnoid hemorrhage, with a mean age of 57.7 years, the admission Glasgow Coma Scale median score was 14 (eye, 4; verbal, 4; motor, 6), and the mRS median was 0 on admission and 4 at discharge. Correlation between standard deviation of PLR values and discharge mRS was moderate and negative (r = −0.3 to −0.47, P
Source: Journal of Neuroscience Nursing - Category: Neuroscience Tags: Article Source Type: research

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Abstract The role of the renin-angiotensin-aldosterone system and arginine vasopressin (AVP) as humoral components in maintaining blood pressure (BP) during hemorrhagic shock (HS) is well established. However, little is known about the role of angiotensin II (Ang II) and AVP in the control of preganglionic sympathetic neuron activity. We studied the effects evoked by spinal Ang II type I (AT1) and V1a receptors antagonism on cardiovascular and sympathetic responses during HS. A catheter (PE-10) was inserted into the subarachnoid space and advanced to the T10-11 vertebral level in urethane-anesthetized rats. The ef...
Source: European Journal of Pharmacology - Category: Drugs & Pharmacology Authors: Tags: Eur J Pharmacol Source Type: research
We examined the effect of RD on early brain injury (EBI) and delayed cerebral ischemia (DCI) as a primary endpoint, and also explored the effect on cerebral vasospasm (CVS) as a secondary endpoint. Although RD did not exert significant effects on primary endpoint, RD signi ficantly prevented CVS and reduced SAH-induced increases in the number of phosphorylated extracellular signal-regulated kinase (ERK)-positive endothelial cells, cyclooxygenase-2 expression, and macrophage infiltration in major cerebral arteries. Moreover, RD significantly decreased the areas display ing dopamine β-hydroxylase and glial fibrillary ac...
Source: Translational Stroke Research - Category: Neurology Source Type: research
Conclusions Acute oculomotor palsy may be a risk factor for rupture of ipsilateral unruptured aneurysms, but more basic research and clinical trial evidence of intracranial aneurysms are needed to confirm this.
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
Background: Portable automated infrared pupillometry is becoming increasingly popular. To generate an objective reference base, the Neurological Pupil index (NPi) which combines different values of the pupillary light reflex is being introduced into clinical practice. In this explorative study, we examined different aspects of the NPi in relation to clinical severity and outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). Materials and Methods: Patients with serial assessment of the NPi (NeurOptics pupillometer NPi-200, Irvine, CA) starting no later than day 2 after aSAH onset were included in the stud...
Source: Journal of Neurosurgical Anesthesiology - Category: Anesthesiology Tags: Clinical Reports Source Type: research
Conclusions: Magnesium sulfate is an important adjuvant drug in the practice of anesthesia, with several clinical effects and a low incidence of adverse events when used at recommended doses. Introduction Magnesium is the fourth most common ion in the body, and it participates in several cellular processes, including protein synthesis, neuromuscular function and stability of nucleic acid, as well as regulating other electrolytes such as calcium and sodium. Magnesium acts as a cofactor in protein synthesis, neuromuscular function and stability and the function of nucleic acids. It is a component of adenosine 5-triph...
Source: Frontiers in Pharmacology - Category: Drugs & Pharmacology Source Type: research
Conclusions: This combined maneuver with endovascular embolism as complementary pretreatment for radical surgery is useful for a case with high-flow shunting and large venous pouches. PMID: 30775056 [PubMed]
Source: Surgical Neurology International - Category: Neurosurgery Tags: Surg Neurol Int Source Type: research
CONCLUSIONSIsolated sonographic vasospasm does not seem to correlate with NPi changes, as the latter likely reflects an ischemic neurological injury. NPi changes are strongly associated with the advent of DCI and could be an early herald of clinical deterioration. PMID: 30641848 [PubMed - as supplied by publisher]
Source: Journal of Neurosurgery - Category: Neurosurgery Authors: Tags: J Neurosurg Source Type: research
Reversible cerebral vasoconstriction syndrome (RCVS) is a segmental constriction of cerebral arteries which exposes the patient to cerebral ischaemia and haemorrhage. Its pathophysiology is unknown. Disequilibrium in the regulation of the cerebral arterial tone (sympathetic overactivity) seems to be involved [1]. The postpartum period is a frequent contributor to severe RCVS [1]. Since there is no proven treatment, one may consider milrinone, a vasodilator occasionally used for vasospasm treatment after aneurysmal subarachnoid haemorrhage (ASAH) [2].
Source: Journal of the Neurological Sciences - Category: Neurology Authors: Tags: Letter to the Editor Source Type: research
Conclusion A rare case of multiple ruptured aneurysms on the subarcuate artery was reported in a patient with a Borden type I dAVF at the transverse-sigmoid sinuses manifesting as subarachnoid hemorrhage. Onyx embolization of the parent artery occlusion was feasible and useful in treating this type of feeding artery aneurysm of the AICA with a dAVF. PMID: 30227805 [PubMed - as supplied by publisher]
Source: Interventional Neuroradiology - Category: Radiology Tags: Interv Neuroradiol Source Type: research
Authors: Cai K, Ni Y, Zhang Y, Shen L, Ji Q, Cao M Abstract OBJECTIVE: to evaluate whether postoperative heart rate variability (HRV) predicts short-term outcomes in patients undergoing coil embolization of ruptured aneurysms. METHODS: Consecutive patients receiving endovascular coiling to treat aneurysmal subarachnoid hemorrhage (SAH) were retrospectively reviewed between November 2011 and December 2014 in the authors' institution. Heart rate (HR) and blood pressure (BP) recorded in the initial 24 h after endovascular treatment were extracted along with other clinical data. HR variability (HRV) and BP var...
Source: Neurological Research - Category: Neurology Tags: Neurol Res Source Type: research
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