Research Reports - Side of pupillary mydriasis predicts the cognitive prognosis in patients with severe traumatic brain injury

Acta Anaesthesiol Scand. 2015 Mar;59(3):392-405

Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU),
Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Unidade
de Terapia Intensiva, Hospital Governador Celso Ramos (HGCR), Florianópolis, SC,
Brazil; Unidade de Terapia Intensiva, HU, UFSC, Florianópolis, SC, Brazil.

BACKGROUND: Pupils' abnormalities are associated to bad prognosis in traumatic
brain injury. We investigated the association between the side of pupil mydriasis
and the long-term cognitive performance of patients with severe traumatic brain
injury (TBI).
METHODS: We analyzed the cognitive performance of patients admitted at the
intensive care unit with isochoric pupils (IP, n = 28), left mydriasis (LM,
n = 10), right mydriasis (RM, n = 9) evaluated in mean 2.5 years after the severe
TBI and controls (n = 26) matched for age, sex and education level.
RESULTS: Patients and controls had similar scores in the four WAIS-III
investigated subtests. In comparison with controls, LM patients had lower scores
in Letters and Category Fluency and IP patients in Category Fluency. Among the 10
evaluated memory tests, LM patients had lower scores than controls in eight, RM
patients in two and IP in three memory tests. IP and RM were 3.5 to nine times
more associated to significant impairment (cognitive scores under the percentile
10 of controls) in six of 16 investigated cognitive tests. LM was six to 15 times
more associated to significant impairment in 10 of 16 cognitive tests. The
association among the pupil abnormalities and cognitive performances remained
significant after the multiple linear regression analysis controlling for age,
gender, admission coma Glasgow scale and serum glucose, presence of associated
trauma, and cranial computed tomography abnormalities.
CONCLUSION: Side of admission pupil abnormalities may be a useful variable to
improve prognostic models for long-term cognitive performance in severe TBI
patients.

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