Ropper A H
Neurological/Neurosurgical Intensive Care Unit, Massachusetts General Hospital, Boston.
Neurology. 1990 Nov;40(11):1707-9. doi: 10.1212/wnl.40.11.1707.
I serially examined the pupil opposite the one already enlarged from transtentorial herniation in 13 patients. The main abnormalities, stereotyped in most patients, were an initially diminished light reaction with a 2.5- to 4-mm-diameter pupil, followed by slight reduction in size, and then reenlargement to greater than original size, all with preserved roundness. Subsequent deterioration varied among patients, but a transitional oval shape was infrequent and oculomotor function was preserved until both pupils were enlarged and fixed. Once the pupil on the side of a mass enlarges, heralding herniation, subsequent deterioration can be appreciated through changes in reactivity and size of the opposite pupil.
我连续检查了13例经小脑幕切迹疝已出现瞳孔散大一侧对侧的瞳孔。大多数患者的主要异常表现具有刻板性，起初是光反应减弱，瞳孔直径为2.5至4毫米，随后尺寸略有缩小，然后再次扩大至大于原始大小，所有这些过程中瞳孔均保持圆形。随后的病情恶化在患者之间存在差异，但椭圆形过渡形状并不常见，动眼神经功能得以保留，直到双侧瞳孔均散大且固定。一旦肿块一侧的瞳孔散大，预示着疝形成，通过对侧瞳孔反应性和大小的变化可察觉到随后的病情恶化。
