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Quantitative pupillometry and radiographic markers of intracranial midline shift: A pilot study

BACKGROUND: Asymmetric pupil reactivity or size can be early clinical indicators of midbrain compression due to supratentorial ischemic stroke or primary intraparenchymal hemorrhage (IPH). Radiographic midline shift is associated with worse functional outcomes and life-saving interventions. Better u...

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Autores principales: Kim, Ivy So Yeon, Balogun, Oluwafemi O., Prescott, Brenton R., Saglam, Hanife, Olson, DaiWai M., Speir, Kinley, Stutzman, Sonja E., Schneider, Nathan, Aguilera, Veronica, Lussier, Bethany L., Smirnakis, Stelios M., Dupuis, Josée, Mian, Asim, Greer, David M., Ong, Charlene J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9763295/
https://www.ncbi.nlm.nih.gov/pubmed/36561299
http://dx.doi.org/10.3389/fneur.2022.1046548
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author Kim, Ivy So Yeon
Balogun, Oluwafemi O.
Prescott, Brenton R.
Saglam, Hanife
Olson, DaiWai M.
Speir, Kinley
Stutzman, Sonja E.
Schneider, Nathan
Aguilera, Veronica
Lussier, Bethany L.
Smirnakis, Stelios M.
Dupuis, Josée
Mian, Asim
Greer, David M.
Ong, Charlene J.
author_facet Kim, Ivy So Yeon
Balogun, Oluwafemi O.
Prescott, Brenton R.
Saglam, Hanife
Olson, DaiWai M.
Speir, Kinley
Stutzman, Sonja E.
Schneider, Nathan
Aguilera, Veronica
Lussier, Bethany L.
Smirnakis, Stelios M.
Dupuis, Josée
Mian, Asim
Greer, David M.
Ong, Charlene J.
author_sort Kim, Ivy So Yeon
collection PubMed
description BACKGROUND: Asymmetric pupil reactivity or size can be early clinical indicators of midbrain compression due to supratentorial ischemic stroke or primary intraparenchymal hemorrhage (IPH). Radiographic midline shift is associated with worse functional outcomes and life-saving interventions. Better understanding of quantitative pupil characteristics would be a non–invasive, safe, and cost-effective way to improve identification of life-threatening mass effect and resource utilization of emergent radiographic imaging. We aimed to better characterize the association between midline shift at various anatomic levels and quantitative pupil characteristics. METHODS: We conducted a multicenter retrospective study of brain CT images within 75 min of a quantitative pupil observation from patients admitted to Neuro-ICUs between 2016 and 2020 with large (>1/3 of the middle cerebral artery territory) acute supratentorial ischemic stroke or primary IPH > 30 mm(3). For each image, we measured midline shift at the septum pellucidum (MLS-SP), pineal gland shift (PGS), the ratio of the ipsilateral to contralateral midbrain width (IMW/CMW), and other exploratory markers of radiographic shift/compression. Pupil reactivity was measured using an automated infrared pupillometer (NeurOptics(®), Inc.), specifically the proprietary algorithm for Neurological Pupil Index(®) (NPi). We used rank-normalization and linear mixed-effects models, stratified by diagnosis and hemorrhagic conversion, to test associations of radiographic markers of shift and asymmetric pupil reactivity (Diff NPi), adjusting for age, lesion volume, Glasgow Coma Scale, and osmotic medications. RESULTS: Of 53 patients with 74 CT images, 26 (49.1%) were female, and median age was 67 years. MLS-SP and PGS were greater in patients with IPH, compared to patients with ischemic stroke (6.2 v. 4.0 mm, 5.6 v. 3.4 mm, respectively). We found no significant associations between pupil reactivity and the radiographic markers of shift when adjusting for confounders. However, we found potentially relevant relationships between MLS-SP and Diff NPi in our IPH cohort (β = 0.11, SE 0.04, P = 0.01), and PGS and Diff NPi in the ischemic stroke cohort (β = 0.16, SE 0.09, P = 0.07). CONCLUSION: We found the relationship between midline shift and asymmetric pupil reactivity may differ between IPH and ischemic stroke. Our study may serve as necessary preliminary data to guide further prospective investigation into how clinical manifestations of radiographic midline shift differ by diagnosis and proximity to the midbrain.
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spelling pubmed-97632952022-12-21 Quantitative pupillometry and radiographic markers of intracranial midline shift: A pilot study Kim, Ivy So Yeon Balogun, Oluwafemi O. Prescott, Brenton R. Saglam, Hanife Olson, DaiWai M. Speir, Kinley Stutzman, Sonja E. Schneider, Nathan Aguilera, Veronica Lussier, Bethany L. Smirnakis, Stelios M. Dupuis, Josée Mian, Asim Greer, David M. Ong, Charlene J. Front Neurol Neurology BACKGROUND: Asymmetric pupil reactivity or size can be early clinical indicators of midbrain compression due to supratentorial ischemic stroke or primary intraparenchymal hemorrhage (IPH). Radiographic midline shift is associated with worse functional outcomes and life-saving interventions. Better understanding of quantitative pupil characteristics would be a non–invasive, safe, and cost-effective way to improve identification of life-threatening mass effect and resource utilization of emergent radiographic imaging. We aimed to better characterize the association between midline shift at various anatomic levels and quantitative pupil characteristics. METHODS: We conducted a multicenter retrospective study of brain CT images within 75 min of a quantitative pupil observation from patients admitted to Neuro-ICUs between 2016 and 2020 with large (>1/3 of the middle cerebral artery territory) acute supratentorial ischemic stroke or primary IPH > 30 mm(3). For each image, we measured midline shift at the septum pellucidum (MLS-SP), pineal gland shift (PGS), the ratio of the ipsilateral to contralateral midbrain width (IMW/CMW), and other exploratory markers of radiographic shift/compression. Pupil reactivity was measured using an automated infrared pupillometer (NeurOptics(®), Inc.), specifically the proprietary algorithm for Neurological Pupil Index(®) (NPi). We used rank-normalization and linear mixed-effects models, stratified by diagnosis and hemorrhagic conversion, to test associations of radiographic markers of shift and asymmetric pupil reactivity (Diff NPi), adjusting for age, lesion volume, Glasgow Coma Scale, and osmotic medications. RESULTS: Of 53 patients with 74 CT images, 26 (49.1%) were female, and median age was 67 years. MLS-SP and PGS were greater in patients with IPH, compared to patients with ischemic stroke (6.2 v. 4.0 mm, 5.6 v. 3.4 mm, respectively). We found no significant associations between pupil reactivity and the radiographic markers of shift when adjusting for confounders. However, we found potentially relevant relationships between MLS-SP and Diff NPi in our IPH cohort (β = 0.11, SE 0.04, P = 0.01), and PGS and Diff NPi in the ischemic stroke cohort (β = 0.16, SE 0.09, P = 0.07). CONCLUSION: We found the relationship between midline shift and asymmetric pupil reactivity may differ between IPH and ischemic stroke. Our study may serve as necessary preliminary data to guide further prospective investigation into how clinical manifestations of radiographic midline shift differ by diagnosis and proximity to the midbrain. Frontiers Media S.A. 2022-12-06 /pmc/articles/PMC9763295/ /pubmed/36561299 http://dx.doi.org/10.3389/fneur.2022.1046548 Text en Copyright © 2022 Kim, Balogun, Prescott, Saglam, Olson, Speir, Stutzman, Schneider, Aguilera, Lussier, Smirnakis, Dupuis, Mian, Greer and Ong. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Kim, Ivy So Yeon
Balogun, Oluwafemi O.
Prescott, Brenton R.
Saglam, Hanife
Olson, DaiWai M.
Speir, Kinley
Stutzman, Sonja E.
Schneider, Nathan
Aguilera, Veronica
Lussier, Bethany L.
Smirnakis, Stelios M.
Dupuis, Josée
Mian, Asim
Greer, David M.
Ong, Charlene J.
Quantitative pupillometry and radiographic markers of intracranial midline shift: A pilot study
title Quantitative pupillometry and radiographic markers of intracranial midline shift: A pilot study
title_full Quantitative pupillometry and radiographic markers of intracranial midline shift: A pilot study
title_fullStr Quantitative pupillometry and radiographic markers of intracranial midline shift: A pilot study
title_full_unstemmed Quantitative pupillometry and radiographic markers of intracranial midline shift: A pilot study
title_short Quantitative pupillometry and radiographic markers of intracranial midline shift: A pilot study
title_sort quantitative pupillometry and radiographic markers of intracranial midline shift: a pilot study
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9763295/
https://www.ncbi.nlm.nih.gov/pubmed/36561299
http://dx.doi.org/10.3389/fneur.2022.1046548
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