The Localizing Value of Asymmetry in Pupillary Size in Severe Head Injury
- 1 May 1994
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Neurosurgery
- Vol. 34 (5), 840-846
- https://doi.org/10.1097/00006123-199405000-00008
Abstract
RELIABLE ASSESSMENT OF the probability that a head injury patient harbors a surgical intracranial lesion is critical to both triage and treatment. The authors analyzed data from 608 patients with severe head injuries (Glasgow Coma Scale score, ≤ 8) in the Traumatic Coma Data Bank to assess the reliability of pupillary asymmetry in predicting the presence and location of an intracranial mass lesion. Of 210 patients with pupillary asymmetry of ≥ 1 mm, 63 (30%) had intracranial mass lesions, 52 (25%) of which were extra-axial in location, 38 (73%) of these located ipsilateral to the larger pupil. Of 51 patients with asymmetry of ≥ 3 mm, 22 (43%) had intracranial mass lesions, 18 (35%) of which were extra-axial in location, 14 (64%) of these located ipsilateral to the larger pupil. For both asymmetry categories, strong interactions were found with age and mechanism of injury, the highest incidence of extra-axial lesions occurring in older patients injured other than as occupants of motor vehicles. The authors developed regression equations that provide a graphic means to predict the presence of an intracranial hematoma using data on pupillary asymmetry, age, and mechanism of injury. This predictive model, interpreted in a hospital- and patient-specific fashion, should be of significant use in directing triage, activating diagnostic and therapeutic resources, and evaluating the utility of exploratory trephination.Keywords
This publication has 15 references indexed in Scilit:
- Determinants of Head Injury Mortality: Importance of the Low Risk PatientNeurosurgery, 1989
- The Differential Survival of Trauma PatientsThe Journal of Trauma and Acute Care Surgery, 1987
- The Impact of Advanced Prehospital Emergency Care on the Mortality of Severely Brain-injured PatientsThe Journal of Trauma and Acute Care Surgery, 1987
- Is Computed Tomographic Scanning Necessary in Patients with Tentorial Herniation?Neurosurgery, 1986
- The outcome from severe head injury with early diagnosis and intensive managementJournal of Neurosurgery, 1977
- ASSESSMENT OF OUTCOME AFTER SEVERE BRAIN DAMAGE A Practical ScaleThe Lancet, 1975
- Prognostic Features in Recovery from Traumatic DecerebrationJournal of Neurosurgery, 1970
- A COMPACT HAND DRILL FOR EMERGENCY BRAIN DECOMPRESSIONThe Journal of Trauma and Acute Care Surgery, 1965
- Cranial trephination for diagnosis and therapy in closed injuries to the head: A five-year reviewThe American Journal of Surgery, 1960
- Clinico-pathological aspects of pressure changes at the tentoriumActa Radiologica, 1956