Department of Neurological Surgery, University of Washington, Seattle, WA, United States; School of Medicine, Creighton University, Omaha, NE, United States.
School of Medicine, Creighton University, Omaha, NE, United States; Department of Neurological Surgery, Weill Cornell Medicine, New York, NY, United States.
J Stroke Cerebrovasc Dis. 2024 Oct;33(10):107922. doi: 10.1016/j.jstrokecerebrovasdis.2024.107922. Epub 2024 Aug 9.
Vasospasm is a complication of aneurysmal subarachnoid hemorrhage (aSAH) that can change the trajectory of recovery and is associated with morbidity and mortality. Earlier detection of vasospasm could improve patient outcomes. Our objective is to evaluate the accuracy of smartphone-based quantitative pupillometry in the detection of radiographic vasospasm and delayed cerebral ischemia (DCI) after aSAH.
We prospectively collected pupillary light reflex (PLR) parameters from patients with aSAH admitted to a neurocritical care unit at a single hospital twice daily using quantitative smartphone pupillometry recordings. PLR parameters included: Maximum pupil diameter, minimum pupil diameter, percent change in pupil diameter, latency in beginning of pupil constriction to light, mean constriction velocity, maximum constriction velocity, and mean dilation velocity. Two-tailed t-tests for independent samples were performed to determine changes in average concurrent PLR parameter values between the following comparisons: (1) patients with and without radiographic vasospasm (defined by angiography with the need for endovascular intervention) and (2) patients with and without DCI.
49 subjects with aSAH underwent 323 total PLR recordings. For PLR recordings taken with (n=35) and without (n=241) radiographic vasospasm, significant differences were observed in MIN (35.0 ± 7.5 pixels with vasospasm versus 31.6 ± 6.2 pixels without; p=0.002). For PLR recordings taken with (n=43) and without (n=241) DCI, significant differences were observed in MAX (48.9 ± 14.3 pixels with DCI versus 42.5 ± 9.2 pixels without; p<0.001).
Quantitative smartphone pupillometry has the potential to be used to detect radiographic vasospasm and DCI after aSAH.
血管痉挛是蛛网膜下腔出血（aSAH）的一种并发症，它会改变恢复的轨迹，并与发病率和死亡率有关。更早地发现血管痉挛可以改善患者的预后。我们的目的是评估基于智能手机的定量瞳孔测量术在检测 aSAH 后放射性血管痉挛和迟发性脑缺血（DCI）中的准确性。
我们前瞻性地收集了一家医院神经重症监护病房收治的 aSAH 患者的瞳孔光反射（PLR）参数，每天两次使用智能手机定量瞳孔测量记录。PLR 参数包括：最大瞳孔直径、最小瞳孔直径、瞳孔直径变化百分比、瞳孔对光收缩开始时的潜伏期、平均收缩速度、最大收缩速度和平均扩张速度。采用两尾独立样本 t 检验来确定以下比较中平均并发 PLR 参数值的变化：（1）有和无放射性血管痉挛（定义为血管造影伴需要血管内介入治疗）的患者之间，以及（2）有和无 DCI 的患者之间。
49 例 aSAH 患者共进行了 323 次总 PLR 记录。对于有（n=35）和无（n=241）放射性血管痉挛的 PLR 记录，MIN（有血管痉挛时为 35.0±7.5 像素，无血管痉挛时为 31.6±6.2 像素；p=0.002）有显著差异。对于有（n=43）和无（n=241）DCI 的 PLR 记录，MAX（有 DCI 时为 48.9±14.3 像素，无 DCI 时为 42.5±9.2 像素；p<0.001）有显著差异。
定量智能手机瞳孔测量术有可能用于检测 aSAH 后的放射性血管痉挛和 DCI。
