Neurological Pupil Index as an Indicator of Neurological Worsening in Large Hemispheric Strokes
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ORIGINAL WORK
Neurological Pupil Index as an Indicator of Neurological Worsening in Large Hemispheric Strokes Tae Jung Kim1,2†, Soo‑Hyun Park3†, Hae‑Bong Jeong1, Eun Jin Ha2,4, Won Sang Cho4, Hyun‑Seung Kang4, Jung Eun Kim4 and Sang‑Bae Ko1,2* © 2020 Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society
Abstract Background/Objective: Cerebral herniation due to brain edema is the major cause of neurological worsening in patients suffering large hemispheric strokes. In this study, we investigated whether quantitative pupillary response could help identify the neurological worsening due to brain swelling in patients with large hemispheric strokes. Methods: Quantitative pupillary assessment using an automated pupillometer (NPi-100) was performed between April 2017 and August 2019 for patients suffering large hemispheric strokes. Consecutive pupillary responses were measured every 2 or 4 h as a part of routine clinical care. We compared the mean neurological pupil index (NPi) val‑ ues, NPi value at the time of neurological deterioration, and percentage change in NPi from the immediate previous value between patients with and without neurological worsening. Results: In this study, 2442 quantitative pupillary assessments were performed (n = 30; mean age, 67.9 years; males, 60.0%). Among the included patients, 10 (33.3%) experienced neurological worsening. Patients with neurological worsening had a significantly lower mean value of NPi and a sudden decrease in the NPi value as compared to those without neurological worsening during the whole monitoring period (3.88 ± 0.65 vs. 4.45 ± 0.46, P
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