1066. Detection of Delayed Cerebral Ischemia In Aneurysmal Subarachnoid Hemorrhage Using Objective Pupillometry
Authors: Salah Aoun, MD; Tarek El Ahmadieh, MD; Aaron Plitt, MD; Vinshen Ban, MD; Matthew MacAllister, MD; Sonja Stutzman, PhD; Babu Welch, MD; Jonathan White, MD; Hunt Batjer, MD; Daiwai Olson, PhD (Dallas, TX)
Cerebral vasospasm causing delayed cerebral injury (DCI) is a source of significant morbidity after subarachnoid hemorrhage (SAH). Automated assessment of the pupillary light reflex has been increasingly used as a reliable way of assessing pupillary reactivity. The aim of this manuscript is to investigate the role of automated pupillometry in the setting of SAH, as a potential adjunct to transcranial doppler (TCD).
Our analysis included patients that had been diagnosed with aneurysmal SAH and admitted to the Neuro-Intensive Care Unit between November 2015 and June 2017. A dynamic infrared pupillometer was used for all pupillary measurements. Most patients had multiple NPI readings daily and we retained the lowest value for our analysis. We aimed to study the association between DCI and sonographic vasospasm, and DCI and NPI readings.
A total of 56 patients were included in the final analysis with 635 paired observations of daily TCD and NPI data. There was no statistically significant association between the NPI value and the presence of sonographic vasospasm. There was a significant association between DCI and sonographic vasospasm; Χ2(1) = 6.4112 p = 0.0113, OR = 1.6419 (CI = 1.1163-2.4150) and between DCI and an abnormal decrease in NPI; Χ2(1) = 38.4456 p<0.001, OR = 3.3930 (CI = 2.2789-5.0517). Twelve patients experienced DCI, with 7 showing a decrease of their NPI to an abnormal range. This change occurred >8 hours prior to the clinical decline 71.4% of the time. The NPI normalized in all patients after treatment of their vasospasm.
Isolated sonographic vasospasm does not seem to correlate with NPI changes, as the latter likely reflects an ischemic neurological injury. NPI changes are strongly associated with the advent of DCI and could be an early herald of clinical deterioration.