1165. Objective Pupillometry As A New Prediction And Assessment Tool For Oculomotor Nerve Injury And Recovery: Potential Practical Implications

Authors: Salah Aoun, MD; Tarek El Ahmadieh, MD; Aaron Plitt, MD; Vinshen ban, MD; Matthew MacAllister, MD; Sonja Stutzman; Baby Welch, MD; Jonathan White; Hunt Batjer, MD; Daiwai Olson, PhD (Dallas, TX)

Introduction: The pupillary light reflex examination is an intrinsic part of any good neurological exam. It can be affected by injury to the eye itself, the afferent and efferent pathways, and more importantly the brain due to stroke, traumatic brain injury, or toxicity. There has been consistent evidence that automated pupillometry assessment can provide superior accuracy and interrater correlation compared to bedside eye examination. Pupillary indices such as the Neurological Pupil Index (NPI) may also provide the treatment team with several hours of warning prior to the advent of herniation syndromes, or third nerve palsy. Pupillometer use is being increasingly implemented on the battlefield, and the playing field after sports-related concussions. Methods: We aimed to portray the unique temporal relationship between NPi change and third nerve palsy occurrence and recovery, in a hospitalized patient that was initially neurologically intact. A 53-year-old woman presented with aneurysmal subarachnoid hemorrhage and headaches. Her aneurysm was treated surgically without complication. After lumbar drainage for hydrocephalus she developed an isolated left third nerve palsy that slowly recovered over the following weeks. Pupillometer data was obtained throughout her hospital stay. Results: A total of 121 sets of pupillary measurements were obtained. The NPi decreased to abnormal levels of less than three, 12 hours before she became symptomatic. The NPi also started improving 24 hours prior to the improvement of her clinical exam. The patient did not display signs of neurological dysfunction related to vasospasm during her stay. Conclusion: The NPi value seems to reliably correlate with third nerve function, and appears to possess predictive temporal properties that could allow practitioner to anticipate neurological injury, as well as recovery. These findings could heavily impact the fields of Neurosciences, Trauma, Military Medicine, Critical Care, and Ophthalmology.