ArticleNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology2026
Quantitative pupillometry as a sensitive tool for detecting hydrocephalus-related physiologic burden after aSAH: a prospective feasibility study.
Article in Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH) is common, but bedside markers of its physiological burden are limited. Quantitative pupillometry (QP) is objective and fast; whether it mirrors hydrocephalus severity is uncertain.
methodsSingle-center cohort of adults with aSAH undergoing ventriculoperitoneal shunting (n = 17). Automated infrared pupillometry (NPi-200) was performed the day before surgery and on post-op day 1, recording Neurological Pupil index (NPi) and constriction/dilation velocities (CV/DV) as overall values (mean of both eyes) and inter-eye asymmetry (|OD–OS|). Pre-op CT markers were combined into a standardized Hydrocephalus Severity Score (HSS; higher=worse).
resultsMean pre-op NPi was 3.81 ± 0.69 and post-op 4.03 ± 0.66; median ΔNPi = + 0.13 (Wilcoxon p = 0.141). Responders (ΔNPi ≥ + 0.5) were 5/14 (35.7%). Cross-sectionally, overall values did not mirror ventricular size: NPi vs. HSS (ρ = 0.37, p = 0.141, q = 0.423) and NPi vs. Evans index (EI) (ρ = 0.09, p = 0.735, q = 0.735) were non-significant; CV/DV vs. HSS were likewise neutral. In contrast, inter-eye CV asymmetry correlated with HSS (ρ = 0.68, p = 0.006, q = 0.017; n = 16) and trended with Evans (ρ = 0.49, p = 0.054, q = 0.161). In age/sex-adjusted models, no radiologic metric, including HSS, reliably explained pathological NPi (< 3).
conclusionsIn shunt-dependent aSAH hydrocephalus, pattern matters more than absolute value. Absolute NPi and mean velocities did not reflect ventricular size, whereas inter-eye constriction-velocity asymmetry captured composite radiologic burden, consistent with lateralized parasympathetic stress. Around shunt placement, QP behaved as a dynamic biomarker, revealing patient-level gains despite flat cohort averages. Findings support trend- and asymmetry-based pupillometry to complement imaging for CSF-pathway reassessment and early post-shunt surveillance, warranting prospective validation.
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