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Neurological Pupil Index as an Indicator of Neurological Worsening in Large Hemispheric Strokes

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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) values, 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 < 0.001; and 29.5% vs. 11.1%, P = 0.006, respectively). All patients with NPi values below 2.8 showed neurological deterioration.

Conclusions

Quantitative monitoring of the pupillary response using an automated pupillometer could be a useful and noninvasive tool for detecting neurological deterioration due to cerebral edema in large hemispheric stroke patients.

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Availability of Data and Materials

Data supporting the findings of this study are available from the corresponding author (Pf. Sang-Bae Ko) on reasonable request.

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Funding

This study was supported by the Youhan Pharmacy (No. 0620160820). The funding organizations had no role in the study or in the preparation of this report.

Author information

Author notes

  1. Tae Jung Kim and Soo-Hyun Park have contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Tae Jung Kim, Hae-Bong Jeong & Sang-Bae Ko

  2. Department of Critical Care Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Tae Jung Kim, Eun ** Ha & Sang-Bae Ko

  3. Department of Neurology, Inha University Hospital, Incheon, Republic of Korea

    Soo-Hyun Park

  4. Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea

    Eun ** Ha, Won Sang Cho, Hyun-Seung Kang & Jung Eun Kim

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  1. Tae Jung Kim
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Contributions

S-BK contributed to the study concept and design. JEK, H-SK, and WSC contributed to the study concept. TJK, S-HP, H-BJ, and EJH contributed to data collection. TJK, S-HP, and S-BK analyzed the result and drafted the manuscript. All authors read and approved the manuscript.

Corresponding author

Correspondence to Sang-Bae Ko.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval/Informed Consent

This study was approved by the Institutional Review Board (IRB) of the Seoul National University Hospital (IRB no. H-1009-062-332), and we obtained the informed consent from the included patients. The need for informed consent was waived by the IRB.

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All authors have read and approved the submitted manuscript and publication.

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Kim, T.J., Park, SH., Jeong, HB. et al. Neurological Pupil Index as an Indicator of Neurological Worsening in Large Hemispheric Strokes. Neurocrit Care 33, 575–581 (2020). https://doi.org/10.1007/s12028-020-00936-0

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