ArticlePloS one2025
Automated quantitative pupillometry as a predictor for transtentorial brain herniation in patients with malignant acute ischemic stroke.
Article in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Integrating Brain Imaging Volumetrics and Quantitative Pupillometry for Predicting Neurologic Deterioration after Large Hemispheric Stroke.Neurocritical care · 2026Article
- Exploring the relative stability of automated infrared pupillometry parameters under sedative and analgesic exposure after cardiac surgery.BMC anesthesiology · 2026Observational
- Crosslinking Surgical Oncology and the Assessments of Hernia Sac Tissues With Malignant Transformations.Cureus · 2025Article
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Authors and funding
5 authors.
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No grant is acknowledged in the PubMed record.
Abstract
Brain herniation can be a life-threatening condition, resulting in poor prognosis and higher fatality rates. We examined whether quantitative characteristics of sequential pupillary light reflex (PLR) could serve as biomarkers for identifying brain herniation in fatal acute stroke cases with anterior circulation involvement admitted to neurological intensive care unit (Neuro-ICU). Automatic pupillometer assessed PLR automatically every 4-6 hours, measuring eight specific features: NPi (Neurological pupil index) score, initial resting and constriction pupil size, constriction change, constriction velocity, constriction latency, and dilation velocity. Generalized estimating equations were used to analyze the main effects of assessment time (3-to-0 hours, just before brain herniation, and 27-to-21 hours, considerably before) and clinical groups. The study involved 59 patients (mean age 68.8 ± 1.6 years, 23 females) divided into herniation (n = 10) and non-herniation (n = 49) groups. The herniation group exhibited significantly lower ipsilateral NPi scores at 3-to-0 hours (1.80 ± 0.44, p < 0.0001) compared to 27-to-21 hours (4.26 ± 2.21). Additionally, the herniation group had a larger ipsilateral pupil size at constriction at 3-to-0 hours (4.01 ± 0.40 mm) compared to 27-to-21 hours (2.11 ± 0.17 mm). Specifically, at 3-to-0 hours, the herniation group had lower NPi scores (1.80 ± 0.44 vs. 3.97 ± 0.13, p < 0.0001) and larger pupil size at constriction (4.01 ± 0.04 mm vs. 2.90 ± 0.10 mm, p = 0.007) compared to the non-herniation group. These findings suggest that evaluating PLR characteristics can aid in the early identification of brain herniation, facilitating timely triage and appropriate surgical management.
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