Fixed and Dilated Pupils by Pupillometer in Lateralized Periodic Discharges: Case Report in the Neurocritical Care Unit
Abstract number :
1.378
Submission category :
18. Case Studies
Year :
2021
Submission ID :
1826406
Source :
www.aesnet.org
Presentation date :
12/4/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:54 AM
Authors :
Christopher Primiani, MD - Johns Hopkins Hospital; Romergryko Geocadin, MD - Neurocritical Care - Johns Hopkins Hospital; Khalil Husari, MD - Neurology - Johns Hopkins Hospital
Rationale: Fixed and dilated pupils (FDPs) have become synonymous of impending or established neurological damage. FDPs have been associated with brainstem injury and portends poor prognosis associated with significant mass effect leading to cerebral herniation syndrome. Rarely, changes in pupillary light response have been described with seizures; however, the loss of pupillary response by neurological pupil index (NPi) have not been well established in seizures or with lateralized periodic discharges (LPDs). The objective of this report is to describe an association of FDP and LPDs.
Methods: We reviewed 106 timepoints throughout May-June 2021 hospital admission for a single patient admitted to our academic NCCU. NeurOptics NPi-200 Pupillometer was utilized to record pupil size and NPi.
Results: Our patient is a 58-year-old woman with AIDS and prior recurrent cryptococcal meningitis complicated by seizure disorder who presented with bilateral tonic clonic seizure evolving into focal motor status epilepticus manifesting with clonic twitching of her L face and thumb. She was initially treated with valproic acid, levetiracetam, and midazolam infusion. Evaluation included two lumbar punctures with bland fluid (WBC < 3, RBC < 1, normal protein/glucose) and opening pressure (18cm H
Case Studies