Karki Bipin V, Shrestha Ninadini, Neupane Ashru, Kc Hony, Shrestha Pramesh Sunder, Acharya Santosh
Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Kathmandu, Nepal.
Nepal J Ophthalmol. 2023 Jan;15(29):105-109. doi: 10.3126/nepjoph.v15i1.27187.
Ophthalmological examination is an important aspect of the neurological assessment in a patient with traumatic brain injury. However, significant periorbital swelling can make direct visualization of the pupils difficult. Ultrasonic examination can be a valuable bedside tool when direct visualization fails.
A case of a seven-year female child who had presented with a history traumatic brain injury is reported here.
The periorbital swelling prevented the direct visualization of the eyes. Bedside evaluation with a multipurpose ultrasound (USG) was used to monitor the pupillary diameter (PD) and the consensual pupillary light reflex (PLR) at regular intervals. The PD was measured in the B-mode while the PLR was monitored in M-mode of the USG. The optic nerve sheath diameter (ONSD) was also monitored as a correlate of intracranial pressure (ICP).
Ophthalmic evaluation of PD and PLR can be easily and objectively done on the bedside using USG especially in cases where the direct visualization of the pupils is difficult due to injuries and swelling of the periorbital tissues. Furthermore, ONSD measurements can also be done to monitor the changes in the ICP.
眼科检查是创伤性脑损伤患者神经评估的重要方面。然而，严重的眶周肿胀会使直接观察瞳孔变得困难。当直接观察失败时，超声检查可以成为一种有价值的床旁工具。
本文报告了一名7岁女童，有创伤性脑损伤病史。
眶周肿胀妨碍了对眼睛的直接观察。使用多功能超声（USG）进行床旁评估，定期监测瞳孔直径（PD）和对光反射（PLR）。在B模式下测量PD，在USG的M模式下监测PLR。还监测视神经鞘直径（ONSD）作为颅内压（ICP）的相关指标。
使用USG可以在床旁轻松、客观地进行PD和PLR的眼科评估，特别是在因眶周组织损伤和肿胀而难以直接观察瞳孔的情况下。此外，还可以进行ONSD测量以监测ICP的变化。
