3/2/2024 0 Comments Causes of fixed dilated pupil![]() Underwent autologous cranioplasty without complication. Four months following his initial injury, he The patient’s neurological exam remained stable he was discharged to inpatient To light (NPi: 1.8 mm) 5 hours after surgery, with NPi 4.1 mm at 24 hours. Postoperatively, his head CT demonstrated adequate decompression. An emergent right decompressive hemicraniectomy (started at 150 min after FDPĭetection) with durotomy and duraplasty was performed. Right-to-left midline shift, and worsening uncal herniation with effacement of the rightġF). An emergent head CT ( Figure 1E) (completed at 100 min afterįDP detection) showed increasing edema around his right frontal contusion, 9 mm Hypertonic saline (administered 130 min after detection of the FDP, following the head CTĪnd en route to the OR) did not change his pupillary exam. Treatment with mannitol (administered 30 min after first noticing the FDP) and 23% Intact, gaze was dysconjugate with limited vertical excursion, and he had right abducens He did not blink to threat, corneal reflexes remained Was able to answer orientation questions, follow commands, and reported bilateral loss of Surprisingly, his mental status exam at the time remained stable (GCS 14: E4, V5, M6). Pupillometer (NeurOptics, IrvineĬA, USA) exam demonstrated a decrease in Neurological Pupil index (NPi) on the right fromĤ.4 to 0 and increased diameter from 2.5 to 4.8 mm (left pupil: NPi 3.6, diameter 2.4 mm). ![]() On HD 8, his right pupil became dilated and unreactive. ContinuousĮlectroencephalographic monitoring showed no evidence of seizures. On HD 7, he became drowsierīut followed commands and remained easily arousable. Right-to-left midline shift from 4 to 7 mm ( Figure 1C) and right uncal herniation ( Figure 1D). Hospital day (HD) 4 demonstrated blossoming of contusions and worsening edema with increased Midline shift, with mildly increased right-to-left subfalcine herniation and similarĮffacement of the right perimesencephalic cistern compared to prior (E and F).įor the next 5 days, the patient’s neurologic exam remained stable, although head CT on Increasing edema around his right frontal contusion, now with 9 mm of right-to-left Head computed tomography obtained after right NPi became 0 showing Mental status showing worsening bifrontal edema with 7 mm of right-to-left midline Repeat head computed tomography obtained due to decreased Head computed tomography at the time of presentation showing bifrontal contusions and Impeding herniation due to intraparenchymal contusions, highlighting that any pupillaryĬhange warrants prompt work-up and intervention. Without deterioration of consciousness has been described due to traumatic subdural andĮpidural hematomas, we report this unusual constellation as a sign of rising ICP and His pupil became reactive 5 hours after surgery. We performed an emergent right-sided decompressive hemicraniectomy Midline shift and interval increase in subfalcine herniation related to increased Head computed tomography showed worsening Produced no improvement in his pupillary exam. Corneal reflexes were intact bilaterally. Gaze was dysconjugate with impaired vertical excursion and inability to fully abduct to Heĭescribed complete loss of vision and could not identify objects or count fingers. The patient was drowsy,Īrousable to tactile stimuli, answering questions, oriented to place and time, followingĬommands on his right side, maintaining Glasgow Coma Scale of 14 (E4, V5, M6). On hospital dayĨ, his right pupil became fixed (NPi 0) and dilated (4.8 mm). With bifrontal contusions and right frontal intraparenchymal hemorrhage. History of hypertension and diabetes mellitus type II presented after being assaulted, While maintaining consciousness and the ability to communicate. We describe an exceptional case ofĪ patient with bifrontal contusions who developed worsening edema and a unilaterally FDP Typically experience a deterioration in consciousness. Patients with fixed and dilated pupils (FDPs) due to rising intracranial pressure (ICP)
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