Servicio de Neurocirugía, Hospital Universitario Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, España.
Neurologia. 2013 Jan-Feb;28(1):41-51. doi: 10.1016/j.nrl.2010.07.028. Epub 2010 Nov 11.
Pupil assessment is a fundamental part of the neurological examination. Size and reactivity to light of each pupil should be recorded periodically since changes in these parameters may represent the only detectable sign of neurological deterioration in some patients. However, there is great intraobserver and interobserver variability in pupil examination due to the influence of many factors, such as the difference in ambient lighting, the visual acuity and experience of the examiner, the intensity of the luminous stimulus, and the method used to direct this stimulus. In recent years, digital cameras have incorporated infrared devices allowing the development of user-friendly portable devices that permit repeated, non-invasive examinations of pupil size and its reactivity to light with an objective, accessible and inexpensive method.
The purpose of this review is to describe the fundamentals of infrared pupillometry and discuss potential applications in the monitoring of neurocritical patients. We also present some recommendations in the routine assessment of pupils in neurocritical patients.
The possibility of evaluating the changes in pupil reactivity in an early, objective and almost continuous way provides a new non-invasive monitoring method. This method could improve the predictive factor of neurological deterioration and the bedside monitoring of the neurological state of the patient, avoiding unnecessary examinations and enabling early therapeutic intervention.
瞳孔评估是神经检查的基本组成部分。由于许多因素的影响，如环境照明的差异、检查者的视力和经验、发光刺激的强度以及引导这种刺激的方法，瞳孔检查存在很大的观察者内和观察者间变异性。近年来，数码相机已经集成了红外设备，允许开发用户友好的便携式设备，这些设备可以使用客观、可及且廉价的方法，对瞳孔大小及其对光的反应进行重复、非侵入性的检查。
本综述的目的是描述红外瞳孔测量的基本原理，并讨论其在神经危重症患者监测中的潜在应用。我们还提出了一些关于神经危重症患者瞳孔常规评估的建议。
以早期、客观和几乎连续的方式评估瞳孔反应变化的可能性提供了一种新的非侵入性监测方法。这种方法可以改善神经恶化的预测因素和患者神经状态的床边监测，避免不必要的检查，并能够进行早期治疗干预。
