School of Medicine, University of Texas Southwestern, Dallas, TX, USA.
Department of Neurology & Neurotherapeutics, University of Texas Southwestern, Dallas, TX, USA.
Sci Rep. 2018 May 3;8(1):6992. doi: 10.1038/s41598-018-25477-7.
The pupillary light reflex (PLR) describes the response when light hits the retina and sends a signal (cranial nerve II) to the Edinger-Westphal Nucleus which via cranial nerve III results in pupillary constriction. The Neurological Pupil index (NPi) and pupil constriction velocity (CV) are two distinct variables that can be observed and measured using a pupillometer. We examine NPi and CV in 27,462 pupil readings (1,617 subjects). NPi values <3.0 and a CV < 0.8 mm/sec were considered abnormal. Regression was used to clarify the effect of pupil size and repeated measures. An odds ratio of abnormal CV given normal NPi (and vice versa) was computed using the glimmixed (SAS) regression. Of 27,462 readings, 49.2% revealed bilaterally normal NPi wtih brisk CV, and 10.8% revealed bilaterally abnormal NPi and slow CV; 9.1% with unilaterally normal NPi and brisk CV where the opposite pupil had an abnormal NPi and slow CV. The remaining 30.9% revealed that one or both PLR had either a normal NPi with slow CV, or abnormal NPi with brisk CV. Brisk CV does not rule out an abnormal PLR; slow CV does not rule in abnormal PLR. Practitioners should consider these implications when interpreting pupillometry readings.
瞳孔对光反射（PLR）描述了当光线照射到视网膜并向 Edinger-Westphal 核发送信号（颅神经 II）时的反应，该信号通过颅神经 III 导致瞳孔收缩。神经瞳孔指数（NPi）和瞳孔收缩速度（CV）是两个可以通过瞳孔计观察和测量的不同变量。我们检查了 27462 次瞳孔读数（1617 名受试者）中的 NPi 和 CV。NPi 值<3.0 和 CV<0.8mm/sec 被认为是异常的。回归用于澄清瞳孔大小和重复测量的影响。使用 glimmixed（SAS）回归计算正常 NPi 下异常 CV 的优势比（和反之亦然）。在 27462 次读数中，49.2%双侧显示正常 NPi 伴快速 CV，10.8%双侧显示异常 NPi 和缓慢 CV；9.1%单侧显示正常 NPi 和快速 CV，对侧瞳孔的 NPi 和缓慢 CV 异常。其余 30.9%表明一个或两个 PLR 要么具有正常的 NPi 和缓慢的 CV，要么具有异常的 NPi 和快速的 CV。快速的 CV 并不能排除异常的 PLR；缓慢的 CV 并不能确定异常的 PLR。从业者在解释瞳孔计读数时应考虑到这些影响。
