The Localizing Value of Asymmetry in Pupillary Size in Severe Head InjuryRelation to Lesion Type and Location
作者:
Randall Chesnut,
Theresa Gautille,
Barbara Blunt,
Melville Klauber,
Lawrence Marshall,
期刊:
Neurosurgery
(OVID Available online 1994)
卷期:
Volume 34,
issue 5
页码: 840-846
ISSN:0148-396X
年代: 1994
出版商: OVID
关键词: Age;Anisocoria;Brain injuries;Epidural hematoma;Head injuries;Mechanism of injury;Prediction;Subdural hematoma
数据来源: OVID
摘要:
RELIABLE ASSESSMENT OF the probability that a head injury patient harbors a surgical intracranial lesion is critical to both triage and treatment. The authors analyzed data from 608 patients with severe head injuries (Glasgow Coma Scale score, ≤ 8) in the Traumatic Coma Data Bank to assess the reliability of pupillary asymmetry in predicting the presence and location of an intracranial mass lesion. Of 210 patients with pupillary asymmetry of ≥ 1 mm, 63 (30%) had intracranial mass lesions, 52 (25%) of which were extra-axial in location, 38 (73%) of these located ipsilateral to the larger pupil. Of 51 patients with asymmetry of ≥ 3 mm, 22 (43%) had intracranial mass lesions, 18 (35%) of which were extra-axial in location, 14 (64%) of these located ipsilateral to the larger pupil. For both asymmetry categories, strong interactions were found with age and mechanism of injury, the highest incidence of extra-axial lesions occurring in older patients injured other than as occupants of motor vehicles. The authors developed regression equations that provide a graphic means to predict the presence of an intracranial hematoma using data on pupillary asymmetry, age, and mechanism of injury. This predictive model, interpreted in a hospital- and patient-specific fashion, should be of significant use in directing triage, activating diagnostic and therapeutic resources, and evaluating the utility of exploratory trephination.
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