![]() Pupillary light reactivity is a validated predictor in both the CRASH (Corticosteroid Randomization after Significant Head Injury) and IMPACT (International Mission for Prognosis and Analysis of Clinical Trials) TBI prognostic models. Monitoring of pupillary function provides information about secondary insults (e.g., high ICP), and sustained or newfound pupillary abnormalities are associated with a worse outcome. Elevated ICP may alter brainstem function and cause abnormalities in pupil size, symmetry, and pupillary light reactivity. Pupillary examination, and in particular pupillary light reactivity, plays a fundamental role in this setting and has both diagnostic and prognostic value. Following the primary cerebral insult, TBI management focuses on the prevention and treatment of secondary brain damage, including intracranial pressure (ICP) control. Traumatic brain injury (TBI) is a leading cause of death and disability worldwide and accounts for around 30% of all injury-related deaths. Sustained abnormal NPi was in turn associated with a more complicated ICP course and worse outcome. In a selected cohort of severe TBI patients with abnormal head CT lesions and predominantly focal cerebral injury, elevated ICP episodes correlated with a concomitant decrease of NPi. 1 % in patients with ICHT-nr and 0.5 % in those without ICHT p = 0.007) and were associated with an unfavorable 6-month outcome (15 % in GOS 1–3 vs. ![]() ![]() Abnormal NPi values were more frequent in patients with ICHT-r ( n = 17 38 % of monitored time vs. ICPmax 30 ± 9 mmHg) were associated with a concomitant decrease of the NPi (baseline 4.2 ± 0.5 vs. Among subjects with ICHT, episodes of sustained elevated ICP ( n = 43, 172 matched ICP-NPi samples baseline ICP 14 ± 5 mmHg vs. ResultsĪ total of 54 patients were studied (mean age 54 ± 21 years, 74% with focal injuries on CT), of whom 32 (59%) had ICHT. non-refractory (ICHT-nr responsive to medical therapy)-and with the 6-month Glasgow Outcome Score (GOS). We further analyzed the relationship of cumulative abnormal NPi burden (%NPi values < 3 during total ICP monitoring time) with intracranial hypertension (ICHT)-categorized as refractory (ICHT-r requiring surgical decompression) vs. This was an observational cohort of consecutive subjects with severe TBI (Glasgow Coma Scale 20 mmHg. Using automated infrared pupillometry, we examined the relationship between the Neurological Pupil index (NPi) and invasive ICP in patients with severe TBI. This underlines the inadequacy of light microscopy as the only diagnostic procedure.Elevated intracranial pressure (ICP) is frequent after traumatic brain injury (TBI) and may cause abnormal pupillary reactivity, which in turn is associated with a worse prognosis. In none of the biopsies was the picture diagnostic in itself. In 13 of 16 patients in whom a biopsy was carried out, the histology supported the clinical diagnosis. They frequently have both photo and plain contact allergy, often to substances used in cosmetics. ![]() Patients with persistent light reactivity are characterized by a particular susceptibility to develop a delayed-type hypersensitivity. 10 of these patients had either a positive photopatch test reaction or a plain contact allergy. 72 patients with chronic polymorphic light eruption were used as a control group. Contact allergy to constituents of oak moss and different lichen compounds was twice as common as allergy to Compositae oleoresins. ![]() 17 patients showed contact or photocontact reactions, of which 12 were positive photopatch test reactions and 11 were plain contact reactions. All reacted adversely to ultraviolet light and some also to longer wavelengths when tested on normal appearing skin. The patient group consisted of 18 elderly male patients with persistent light reactivity who were subjected to extensive phototesting with different wavelengths, including patch and photopatch testing. ![]()
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