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Ultraschall Med 2021; 42(01): 7-9
DOI: 10.1055/a-1256-4791
Editorial

From outer space to earth: Ultrasonographic dynamic pupillometry for autonomic testing and neuro-critical care

Aus dem All zur Erde: Dynamische Ultraschall-Pupillometrie für die autonome Funktionsdiagnostik und Neuro-Intensivmedizin
Uwe Walter
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The assessment of pupil diameter as well as its response to light (pupillary light reflex) and to cutaneous painful stimuli (ciliospinal reflex) is a clinical standard in the evaluation of basic functions of the brainstem, cranial nerves, and the autonomic nervous system. In patients with traumatic brain injury or hypoxic ischemic encephalopathy, testing for the presence versus absence of pupillary reflexes is of high prognostic value already in the first hours after injury [1] [2]. Classically, pupillary responses to stimuli are assessed visually by the responsible physician or nurse. Meanwhile, there are a number of instruments available that allow for quantitative dynamic pupillometry by continuous infrared camera, normal-light eye tracker, or smartphone app-tracked, video recording of pupil diameter in the first seconds or minutes following an external or internal stimulus [3] [4] [5] [6]. Based on the recorded diameter-time function, indices of parasympathetic pupil innervation (constriction amplitude and velocity) and of sympathetic pupil function (dilation amplitude and velocity) can be calculated. Beside applications in neuro-critical care and anesthesiology, such as the prognostication after brain injury and the monitoring of anesthesia [5] [7], dynamic pupillometry allows the separate quantification of sympathetic and parasympathic autonomic function, e. g. for the discrimination of Parkinsonian disorders [3] [8] [9].



Publication History

Article published online:
02 February 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Sandroni C, D'Arrigo S, Nolan JP. Prognostication after cardiac arrest. Crit Care 2018; 22: 150
    CrossrefPubMedSearch in Google Scholar
  • 2 Brennan PM, Murray GD, Teasdale GM. Simplifying the use of prognostic information in traumatic brain injury. Part 1: The GCS-Pupils score: an extended index of clinical severity. J Neurosurg 2018; 128: 1612-1620
    CrossrefPubMedSearch in Google Scholar
  • 3 Muppidi S, Adams-Huet B, Tajzoy E. et al. Dynamic pupillometry as an autonomic testing tool. Clin Auton Res 2013; 23: 297-303
    CrossrefPubMedSearch in Google Scholar
  • 4 Murphy PR, O'Connell RG, O'Sullivan M. et al. Pupil diameter covaries with BOLD activity in human locus coeruleus. Hum Brain Mapp 2014; 35: 4140-4154
    CrossrefPubMedSearch in Google Scholar
  • 5 Larson MD, Behrends M. Portable infrared pupillometry: a review. Anesth Analg 2015; 120: 1242-1253
    CrossrefPubMedSearch in Google Scholar
  • 6 McAnany JJ, Smith BM, Garland A. et al. iPhone-based Pupillometry: A Novel Approach for Assessing the Pupillary Light Reflex. Optom Vis Sci 2018; 95: 953-958
    CrossrefPubMedSearch in Google Scholar
  • 7 Wildemeersch D, Peeters N, Saldien V. et al. Pain assessment by pupil dilation reflex in response to noxious stimulation in anaesthetized adults. Acta Anaesthesiol Scand 2018; 62: 1050-1056
    CrossrefPubMedSearch in Google Scholar
  • 8 Hori N, Takamori M, Hirayama M. et al. Pupillary supersensitivity and visual disturbance in Parkinson's disease. Clin Auton Res 2008; 18: 20-27
    CrossrefPubMedSearch in Google Scholar
  • 9 Park KW, Choi N, Ryu HS. et al. Pupillary dysfunction of multiple system atrophy: Dynamic pupillometric findings and clinical correlations. Parkinsonism Relat Disord 2019; 65: 234-237
    CrossrefPubMedSearch in Google Scholar
  • 10 Ertl M, Barinka F, Torka E. et al. Ocular color-coded sonography – a promising tool for neurologists and intensive care physicians. Ultraschall in Med 2014; 35: 422-431
    Thieme ConnectPubMedSearch in Google Scholar
  • 11 Birnholz JC. Ultrasonic fetal ophthalmology. Early Hum Dev 1985; 12: 199-209
    CrossrefPubMedSearch in Google Scholar
  • 12 Horimoto N, Koyanagi T, Takashima T. et al. Changes in pupillary diameter in relation to eye-movement and no-eye-movement periods in the human fetus at term. Am J Obstet Gynecol 1992; 167: 1465-1469
    CrossrefPubMedSearch in Google Scholar
  • 13 López Ramón y Cajal C. Response of the human fetal pupil to color Doppler: a sign of cognitive function?. Prenat Neonat Med 1998; 3: 580-587
    PubMedSearch in Google Scholar
  • 14 López Ramón y Cajal C. Response of the foetal pupil to vibro-acoustic stimulation: a foetal attention test. Early Hum Dev 2011; 87: 199-204
    CrossrefPubMedSearch in Google Scholar
  • 15 Chiao L, Sharipov S, Sargsyan AE. et al. Ocular examination for trauma; clinical ultrasound aboard the International Space Station. J Trauma 2005; 58: 885-889
    CrossrefPubMedSearch in Google Scholar
  • 16 Sargsyan AE, Hamilton DR, Melton SL. et al. Ultrasonic evaluation of pupillary light reflex. Crit Ultrasound J 2009; 1: 53-57
    CrossrefPubMedSearch in Google Scholar
  • 17 Harries A, Shah S, Teismann N. et al. Ultrasound assessment of extraocular movements and pupillary light reflex in ocular trauma. Am J Emerg Med 2010; 28: 956-959
    CrossrefPubMedSearch in Google Scholar
  • 18 Farina F, Brunner C, Schreiber SJ. et al. Ultrasound examination of the pupil suggestive for carotid dissection. Neurology 2017; 89: 973-974
    CrossrefPubMedSearch in Google Scholar
  • 19 Mohammad K. Assessing pupil reaction to light using ultrasound in a sick neonate with Hypoxic Ischemic Encephalopathy. J Neonatal Perinatal Med 2020; 13: 459-461
    CrossrefPubMedSearch in Google Scholar
  • 20 Kasapas K, Diamantopoulou A, Pentilas N. et al. Invasive and ultrasound based monitoring of the intracranial pressure in an experimental model of epidural hematoma progressing towards brain tamponade on rabbits. Scientific World Journal 2014; 2014: 504248
    CrossrefPubMedSearch in Google Scholar
  • 21 Schmidt FA, Ruprecht K, Connolly F. et al. B-mode ultrasound assessment of pupillary function: Feasibility, reliability and normal values. PLoS One 2017; 12: e0189016
    CrossrefPubMedSearch in Google Scholar
  • 22 Schmidt FA, Connolly F, Maas MB. et al. Objective assessment of a relative afferent pupillary defect by B-mode ultrasound. PLoS One 2018; 13: e0202774
    CrossrefPubMedSearch in Google Scholar
  • 23 Haratz KK, Melcer Y, Leibovitz Z. et al. Ultrasound Nomograms of the Fetal Optic Nerve Sheath Diameter. Ultraschall in Med 2019; 40: 476-480
    Thieme ConnectPubMedSearch in Google Scholar
  • 24 Lochner P, Fassbender K, Knodel S. et al. B-Mode Transorbital Ultrasonography for the Diagnosis of Idiopathic Intracranial Hypertension: A Systematic Review and Meta-Analysis. Ultraschall in Med 2019; 40: 247-252
    Thieme ConnectPubMedSearch in Google Scholar
  • 25 Maissan IM, Dirven PJ, Haitsma IK. et al. Ultrasonographic measured optic nerve sheath diameter as an accurate and quick monitor for changes in intracranial pressure. J Neurosurg 2015; 123: 743-747
    CrossrefPubMedSearch in Google Scholar
  • 26 Walter U, Niendorf T, Graessl A. et al. Ultrahigh field magnetic resonance and colour Doppler real-time fusion imaging of the orbit-a hybrid tool for assessment of choroidal melanoma. Eur Radiol 2014; 24: 1112-1117
    CrossrefPubMedSearch in Google Scholar
  • 27 Hoffmann B, Schafer JM, Dietrich CF. Emergency Ocular Ultrasound – Common Traumatic and Non-Traumatic Emergencies Diagnosed with Bedside Ultrasound. Ultraschall in Med 2020; 41: 618-645
    Thieme ConnectPubMedSearch in Google Scholar
  • 28 Farina F, Vosko MR, Baracchini C. et al Ultrasound Examination of the Pupil – A New Tool for the Neuro-Ophthalmological Assessment. Ultraschall in Med 2021; 42: 84-91 . doi:10.1055/a-1208-1482
    Thieme ConnectPubMedSearch in Google Scholar
  • 29 Yic CD, Prada G, Paz SI. et al. Comparison of ultrasonographic versus infrared pupillary assessment. Ultrasound J 2020; 12: 38
    CrossrefPubMedSearch in Google Scholar