Abstract Details

Title Anisocoria and Poor Pupil Reactivity in the Neuro ICU

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) S48 - Neurocritical Care: Traumatic Brain Injury and Goals-of-care Decision-making (2:48 PM-3:00 PM)

Poster/Presentation
Number 010

Objective To describe the incidence of clinical anisocoria and its relationship with poor-pupil reactivity in a heterogenous Neuro-ICU population.

Background Anisocoria is an asymmetry of pupil size classically considered significant when size difference is at least 1mm. Anisocoria has multiple etiologies, including intracranial compression of pupillary pathways. In certain contexts, anisocoria prompts emergent diagnostic workup and/or treatment. Its incidence and association with poor pupil reactivity in Neurocritical-Care patients remains poorly described.

Design/Methods We collected pupil data on 314 Neuro-ICU patients 18 or older from two hospitals between 2016-2018. We used mixed-effects logistic regression adjusting for age/diagnosis to analyze the association of new-onset anisocoria and pupil reactivity (NPi) at the time of/prior-to pupil asymmetry.

Results Anisocoria occurred in 1318/13,284 pupil observations (9.9%), and in 187/314 (60%) patients. 649 anisocoric observations (49.2%) occurred concurrently with poor reactivity (NPi< 3), and 585 anisocoric episodes were “new-onset,” or occurred after minimum two non-anisocoric observations. In our mixed-effects model, new-onset anisocoria was associated with NPi at the time of (B=0.08, p<0.001), and prior to anisocoria (median time to anisocoria, 2hrs) (B=0.04, p=0.008). Effects were independent of age/diagnosis. In specific subgroups, anisocoria occurred in 33/44 Brain Tumors (75%), 25/39 TBIs (64%), 31/49 Strokes (63%), and 42/71 IPHs (59%). Poor NPi and anisocoria occurred in 15 (60%), 17 (52%), 17 (40%) and 9 (29%) patients with TBI, Brain-Tumor, IPH and Stroke respectively. New-onset anisocoria was significantly associated with prior NPi in the stroke subgroup (B=0.13, p=0.009) and near-significant with IPH (B=0.04, p=0.06) after adjusting for age.

Conclusions

In our cohort, anisocoria occurred in 10% of pupil measurements and 60% of patients in the Neuro-ICU. Roughly half of anisocoric episodes occur concomitantly with poor-pupil reactivity. It is also significantly associated with prior poor-pupil reactivity. Further work is needed to determine whether prior poor-pupil reactivity is a sensitive and specific biomarker of clinical anisocoria.

Authors/Disclosures
Charlene J. Ong, MD (Boston University) PRESENTER	Dr. Ong has nothing to disclose.
	No disclosure on file
Hanife Saglam, MD (West Virginia University)	Dr. Saglam has nothing to disclose.
David M. Greer, MD, FAAN (Boston University School of Medicine)	Dr. Greer has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Thieme, Inc. Dr. Greer has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for multiple. The institution of Dr. Greer has received research support from Becton, Dickinson and Company. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has received publishing royalties from a publication relating to health care.

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