NeurOptics | Pupillary evaluation for differential diagnosis of coma
pupil, pupil exam, pupil examination, pupil pressure measurement, pupil reaction, pupillary, pupillary light reflex, pupillometer, pupillometry, stroke, TBI, trauma, constriction velocity, critical care, critical care nursing, intraocular pressure, modified rankin scale, neurocritical care, neurologist, neuroscience nursing, neurosurgeon, medical devices, NIH Stroke Scoring Scale, NIHSS, ophth, ophthalmic, ophthalmic surgery, ophthalmologist, ophthalmology, opthal, optometrist to ophthalmologist, PERL
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Pupillary evaluation for differential diagnosis of coma

Pupillary evaluation for differential diagnosis of coma

 

Category: Critical Care

 

Tokuda Y, Nakazato N, Stein GH., Pupillary evaluation for differential diagnosis of coma., Postgrad Med J. 2003 Jan;79(927):49-51.

 

OBJECTIVES: To determine the usefulness of bedside evaluation of pupils in determining the aetiology of coma by adopting a probabilistic approach. PATIENTS AND METHODS: One hundred and fifteen consecutive patients presenting with coma were enrolled in this prospective cohort during the 12 month study period in the emergency room of a community teaching hospital. Patients underwent structured clinical examinations and laboratory and imaging tests. Assignment of aetiology of coma was based on strict adherence to predetermined criteria and achieved by consensus of the two physician investigators. One year follow up was obtained in all patients. RESULTS: Aetiology of coma was determined in 98% of the patients. It was metabolic in 69 patients (60%) and structural in 46 patients (40%). Metabolic causes included drug overdose, acute alcohol intoxication, hypoglycaemia, sepsis, and pneumonia. Structural causes included intracerebral haemorrhage, subarachnoid haemorrhage, cerebral infarction, subdural haematoma, and epidural haematoma. Multivariate logistic regression analysis showed light reflex loss (likelihood ratio for positive test result 3.59) and anisocoria (likelihood ratio for positive test result 9.0) as independent predictors of structural origin. CONCLUSIONS: In this prospective study of patients presenting to the emergency room of a community based teaching hospital with coma, in about 60% the coma is of metabolic origins and in about 40% of structural origins. Light reflex loss and anisocoria suggest a structural aetiology.