Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
Department of Neurology and Neurosurgery, University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
Neurol Sci. 2022 Sep;43(9):5377-5382. doi: 10.1007/s10072-022-06230-5. Epub 2022 Jun 25.
Lumbar drain (LD) trials are used to temporarily divert CSF in order to predict clinical improvement prior to definitive CSF diversion in patients with a diagnosis of normal pressure hydrocephalus. New technology has improved clinical detection of subtle pupillary changes that may occur during CSF diversion trials. The aim of this study was to determine whether pupillary light response as recorded by automated pupillometry could be used to predict response during lumbar drain trials.
The authors prospectively gathered quantitative pupillometry data on admission and following each CSF diversion in a cohort of 30 consecutive patients with a presumptive diagnosis of normal pressure hydrocephalus admitted to a university hospital for elective LD trial between January 1, 2020 and March 30, 2021. The value of pupillometry in predicting success of lumbar drainage in alleviating symptoms was correlated to clinical improvement during lumbar drainage.
Of the 29 patients undergoing a 4-day LD trial, 16 (55.2%) demonstrated clinical improvement. Pre-drainage pupillometry values did not differ between patients who had clinical improvement or no clinical improvement. Constriction velocity improved compared to baseline in patients who had a successful lumbar drain trial (LD +). There was a non-significant trend towards improved constriction velocity and improved dilation velocity found in patients even after the first aliquot drainage.
Baseline pupillary function by automated pupillometry did not predict clinical improvement during lumbar drain trials. Improvement in constriction and dilation velocity may be useful to monitor at the outset, after the initial drainage, and at completion of lumbar drain trials.
腰椎引流（LD）试验用于暂时转移 CSF，以便在诊断为正常压力脑积水的患者进行确定性 CSF 引流之前预测临床改善。新技术提高了对 CSF 引流试验期间可能发生的微妙瞳孔变化的临床检测能力。本研究旨在确定通过自动瞳孔计记录的瞳孔光反应是否可用于预测腰椎引流试验期间的反应。
作者前瞻性地收集了 2020 年 1 月 1 日至 2021 年 3 月 30 日期间，30 例连续疑似正常压力脑积水患者入院时和每次 CSF 引流后的定量瞳孔计数据，这些患者在大学医院接受择期 LD 试验。瞳孔计在预测腰椎引流缓解症状的成功率方面的价值与腰椎引流期间的临床改善相关。
在接受 4 天 LD 试验的 29 例患者中，16 例（55.2%）表现出临床改善。有临床改善或无临床改善的患者的预引流瞳孔计值没有差异。与成功的腰椎引流试验（LD+）相比，收缩速度在基线时有所改善。即使在第一次引流后，收缩速度和扩张速度的改善也有非显著趋势。
自动瞳孔计的基线瞳孔功能不能预测腰椎引流试验期间的临床改善。收缩和扩张速度的改善可能有助于在开始时、初始引流后和腰椎引流试验完成时进行监测。
