Pupillary Abnormalities Research Articles

THE RELATIONSHIP OF PUPIL SIZE WITH REFRACTIVE EROR IN METABOLIC SYNDROME AND NON-METABOLIC SYNDROME: POPULATION AMONG RURAL POPULATION IN MALANG

Purpose: This study aims to assess the relationships between pupil size and refractive errors in both metabolic syndrome and non-metabolic syndrome populations residing in rural areas of Malang. Methods: A descriptive study was carried out in 2019 across three villages in Malang districts. All attending participants underwent a comprehensive ocular examination, including pupil size assessment. Pupil abnormalities were defined as deviations from the normal diameter of 2-4 mm in bright light. Clinically relevant refractive errors included hyperopia (SphEq value ? 0.25 D), myopia (SphEq value ? -0.25 D), and astigmatism (cylinder ? 0.25 D). Blood samples gauged serum fasting glucose, high-density lipoprotein cholesterol, and triglyceride levels. Waist circumference, systolic, and diastolic blood pressure were measured. Metabolic Syndrome diagnosis followed the 2006 International Diabetes Foundation criteria. Participants were categorized into metabolic syndrome and non-metabolic syndrome groups. Results: The examination involved 953 participants, encompassing 944 right eyes and 942 left eyes. For the right eye, 434 eyes showed emmetropia, 252 exhibited myopia, 141 had hyperopia, and 117 presented astigmatism. Pupillary abnormalities were linked to astigmatism, but lacked significance (p = 0.893). The left eye results indicated 444 eyes with emmetropia, 244 with myopia, 138 with hyperopia, and 116 with astigmatism. Correlation with pupillary abnormalities yielded a non-significant p-value of 0.864. Pupil size outcomes in metabolic syndrome (499 eyes) and non-metabolic syndrome (454 eyes) were not significant (p = 0.649). Conclusion: Refractive error does not correlate with pupil size in metabolic syndrome and nonmetabolic syndrome.

RELATIONSHIP OF PUPIL SIZE WITH REFRACTIVE ERROR IN METABOLIC SYNDROME AND NON METABOLIC SYNDROME: AMONG RURAL POPULATION IN MALANG

Introduction & ObjectivesNearly one in four Indonesians has metabolic syndrome (MS). One of the microvascular side effectsin Metabolic Syndrome affects the eyes. The aim of this study to evaluate the relationship of pupilsize with refractive error in MS and non-MS groups among rural populations in Malang.
 MethodsA descriptive study was carried out in 2019 in three villages in Malang districts. A detailed ocularexamination was conducted on all participants who attended a research facility. We definedpupillary abnormalities and clinically important refractive errors. Blood samples were obtained todetermine the parameter of the metabolic syndrome by IDF 2006 criteria. Subjects were classifiedinto 2 groups: Metabolic Syndrome status and non metabolic syndrome.
 Results953 participants completed the examination which consists of 944 right eyes and 942 left eyes. Theresults of visual acuity on the right eye: emmetropia in 434 eyes, myopia with 252 eyes, hyperopiawith 141 eyes, and astigmatism with 17 eyes where if it is not significant if associated with pupillaryabnormalities (P-value 0.893). On the left eye, the emmetropia results were 444 eyes, while formyopia were 244 eyes, hyperopia as many as 138, and astigmatism in 116 eyes and if associatedwith pupillary abnormalities, the result also not significant (P-value 0.864). The result of pupil sizewith metabolic syndrome 499 eye and non syndrome metabolic 454 eye are not significant (p-value0.649).
 ConclusionRefractive error didn’t relate pupil size in metabolic syndrome and non metabolic syndrome.

Sudden Ocular Complication after Snake Bite

Introduction : A snakebite constitutes a common acute medical emergency and has several systemic and even ocular consequences. Snake venom neurotoxins act mainly on the peripheral nervous system at the neuromuscular junction and can affect the cranial nerves. Neurological symptoms that relate to cephalic muscle paralysis include exotropia, ptosis, diplopia and ophthalmoplegia.
 Case Illustration : A 17 years old man came to emergency department with painful swelling on his left hand and sudden blurred vision right after his left hand were bitten by venomous snake in the rice field. Diplopia and ptosis were developed several hours after admission. On eye examination, visual acuity was 0,05 on right eye and 0,8 on left eye, abnormal pupillary reflects on both eyes were present, pupil dilatation, limited eye movement and ptosis were present, Intraocular pressure were 23,7 mmHg on right eye and 24,5 mmHg on left eye. Antivenom was administered immediately. He received cycloplegic, timolol eyedrop, and prednisolone eyedrop for ocular treatment
 Discussion : Ocular complications are rare and uncommon but they may lead to sight-threatening conditions. Snake venom neurotoxins act mainly on the peripheral nervous system at the neuromuscular junction and can affect the cranial nerves. Mild neurological symptoms that relate to cephalic muscle paralysis include exotropia, ptosis, diplopia and ophthalmoplegia.
 Conclusion : This study presented a rare case of systemic ocular complication as a result of a snake bite. Ophthalmoplegia induced ocular discomfort for an extended period is a rare symptom of snake-bites. Combined treatment of steroid with antivenom may improve the recovery from sudden ocular manifestation in snake bite.

Emergency decompressive surgery in patients with transtentorial brain herniation and pupillary abnormalities: the importance of improved pupillary response after osmotherapy and surgery.

The predictors of survival and functional recovery following emergency decompressive surgery in patients with transtentorial brain herniation, particularly those with pupillary abnormalities, have not been established. In this study, the authors aimed to assess the outcome of patients with intracranial mass lesions, transtentorial brain herniation, and nonreactive mydriasis, following emergency surgical decompression. A retrospective chart review was performed of all patients with transtentorial herniation and pupillary abnormalities who underwent craniotomy or craniectomy at two trauma and stroke centers between 2016 and 2022. The functional outcome was determined using the modified Rankin Scale (mRS). Forty-three patients, 34 men and 9 women with a mean age of 47 years (range 16-92 years), were included. The underlying etiology was traumatic brain injury in 33 patients, hemorrhagic stroke in 8 patients, and tumor in 2 patients. The median preoperative Glasgow Coma Scale score was 3 (range 3-8), and the median midline shift was 9 mm (range 1-29 mm). Thirty-two patients (74.4%) had bilaterally fixed and dilated pupils. The median time to surgery (from pupillary changes) was 133 minutes (mean 169 minutes, range 30-900 minutes). Eighteen patients (41.9%) died postoperatively. After a median follow-up of 12 months (range 3-12 months), 11 patients (26.8%) had a favorable functional outcome, while 10 remained severely disabled (mRS score 5). On univariate analysis, younger age (p < 0.001), less midline shift (p = 0.049), and improved pupillary response after osmotic therapy (p < 0.01) or decompressive surgery (p < 0.001) were associated with favorable outcomes at 3 months. With aggressive medical and surgical management, patients with transtentorial brain herniation, including those with bilaterally fixed and dilated pupils, may have considerable rates of survival and functional recovery. Young age, less midline shift, and improved pupillary response following osmotic therapy or decompressive surgery are favorable prognosticators.

Assessing Cognitive Effort in Ménière's Disease: Pupillometry as a Novel Tool for Postural Control.

This study aimed to investigate the utility of pupillometry as a measure of cognitive effort in individuals with Ménière's disease experiencing chronic postural destabilization. By integrating pupillometry with static posturography, we sought to gain deeper insights into the cognitive demands and arousal levels associated with postural control in this specific patient population. The study included 36 patients who met the diagnostic criteria for Ménière's disease and a control group comprising 36 healthy volunteers. We performed static posturography using a computerized static posturography platform to objectively assess postural imbalance. Additionally, pupillometry was recorded using infrared video-oculoscopy. Pupil dilation was measured before and after participants walked for 7 steps on-site with their vision obscured. Baseline tonic pupil size showed no significant difference between healthy controls and Ménière's patients. However, after walking stimulation, Ménière's patients exhibited highly significant abnormal walking-induced pupil dilation. This suggests increased arousal in response to the challenging task of walking with closed eyes, linked to static upright stance imbalance as correlated with posturography parameters. Pupillometry holds promise as an objective tool to assess cognitive effort and arousal during postural control in Ménière's disease. Implementing pupillometry in clinical practice could enhance the management of postural instability in these patients. Our findings contribute to the understanding of cognitive aspects in balance control and open new avenues for further investigations in vestibular dysfunction.

Understanding Visual Disorders through Correlation of Clinical and Radiologic Findings.

Patients presenting with visual disturbances often require a neuroimaging approach. The spectrum of visual disturbances includes three main categories: vision impairment, ocular motility dysfunction, and abnormal pupillary response. Decreased vision is usually due to an eye abnormality. However, it can also be related to other disorders affecting the visual pathway, from the retina to the occipital lobe. Ocular motility dysfunction may follow disorders of the cranial nerves responsible for eye movements (ie, oculomotor, trochlear, and abducens nerves); may be due to any abnormality that directly affects the extraocular muscles, such as tumor or inflammation; or may result from any orbital disease that can alter the anatomy or function of these muscles, leading to diplopia and strabismus. Given that pupillary response depends on the normal function of the sympathetic and parasympathetic pathways, an abnormality affecting these neuronal systems manifests, respectively, as pupillary miosis or mydriasis, with other related symptoms. In some cases, neuroimaging studies must complement the clinical ophthalmologic examination to better assess the anatomic and pathologic conditions that could explain the symptoms. US has a major role in the assessment of diseases of the eye and anterior orbit. CT is usually the first-line imaging modality because of its attainability, especially in trauma settings. MRI offers further information for inflammatory and tumoral cases. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.

Decompressive craniectomy at the National Hospital of Niamey: Prospective study of the epidemioclinical profile, indications, surgical techniques, and results in a context of limited resources.

Decompressive craniectomy (DC) is a neurosurgical technique that is gaining renewed interest due to the worldwide resurgence of head injuries. We aimed to analyze the quality of management and prognosis of patients who underwent this surgery in the context of limited resources. This was a prospective, longitudinal, descriptive, and analytical study following STROBE, lasting 36 months at the National Hospital of Niamey in patients who had undergone DC. P ≤ 0.05 was considered significant. During our study, we collected 74 cases of DC. The mean age was 32.04 years (10-75 years), with male predominance (91.89%). DC was mainly performed following head trauma (95.95%), the main cause of which was road traffic accidents (76%; 54/71). On admission, most patients presented with altered consciousness (95.95%) and pupillary abnormalities (62.16%). The average time between brain damage and brain scan was 31.28 h, with parenchymal contusion being the most frequent lesion (90.54%). The majority of patients (94.59%) underwent decompressive hemicraniectomy. Postoperative complications accounted for 71.62% of all cases, with 33.78% resulting in death. Among survivors, 55.10% had neurological sequelae at the last consultation (27/49). The main factors associated with the risk of death and morbidity were a Glasgow coma score ≤8, pupillary abnormality on admission, the presence of signs of brain engagement, and a long admission delay. Our study shows that the impact of limited resources on our care is moderate. Future research will concentrate on long-term monitoring, particularly focusing on the psychosocial reintegration of patients post-DC.

Assessment of the activity of Trauma Centers for Children in Poland in 2021

Aim: Injuries are dominant causes of death and hospitalization among children and adolescents. In some countries, there are designated pediatric trauma centers (PTCs) that offer multiple levels of care for trauma patients. Our aim is to demonstrate that the criteria in Polish PTCs may not identify a large group of patients with life-threatening conditions, and they may be referred to centers with lower capabilities. Material and methods: We analyzed all trauma patients transported by ambulance to the Emergency Department in Pediatric Teaching Hospital of University Clinical Center of the Medical University of Warsaw in 2021. Results: Out of 981 pediatric trauma patients, 27 qualified for PTC. Key factors determining which children are more likely to qualify for PTC include the influence of alcohol, falls from heights, the need for analgesics, and fluid therapy. Physical examination abnormalities more likely found among patients qualified for PTC were: GCS≤13, abnormal pupillary reaction, abnormal pupil width, seizures, a decrease in systolic blood pressure, abnormal heart rate, and a decrease in oxygen saturation. There is a significant group of patients who do not meet PTC criteria but present a risk to life or health. Conclusions: Only a small number of admitted children met the qualification criteria for PTC. It seems that we should not assess a patient solely based on preestablished criteria, but the universality of this problem requires the creation of a segregation system that would allow access to patients more individually.

The Efficacy of Traumatic Brain Injury Treatment by Neurotrauma Specialists.

Since the establishment of Regional Trauma Centers (RTCs) in Korea, significant efforts have been made to improve the quality of care for patients with trauma. Simultaneously, the Department of Neurosurgery assigned neurotrauma specialists to RTCs to provide specialized care to patients with traumatic brain injury (TBI). In this study, we sought to determine whether neurotrauma specialists, compared to general neurosurgeons, could make a significant difference in treatment outcomes of patients with TBI. In total, 156 patients with acute TBI who required decompression were included. We reviewed their records and compared the characteristics, outcomes, and prognosis of those who received surgical treatment from either neurotrauma specialists or general neurosurgeons at our institution. A significant difference was observed between treatment by trauma neurosurgery specialists and general neurosurgeons in time to surgery, with trauma specialists experiencing shorter surgical delays. However, no significant differences existed in mortality rates or Extended Glasgow Outcome Scale scores. Univariate and multivariable regression analyses revealed that lower Glasgow Coma Scale scores, an abnormal pupil reflex, larger transfusion volume, and prolonged time from emergency room admission to surgery were associated with high mortality rates. Neurotrauma specialists can provide prompt surgical treatment to patients with TBI compared to general neurosurgeons. Our study did not reveal a significant difference in outcomes between the two groups. However, it is clear that rapid decompression is effective in patients with impending brain herniation. Therefore, the effectiveness of neurotrauma specialists needs to be confirmed through further systematic studies.

Clinical characteristics and functional outcome of surgically treated adult head trauma patients with acute subdural hematoma: Ethiopian tertiary hospitals experience

BackgroundAcute subdural hematoma (ASDH) is one of the most common and devastating lesions in traumatic brain injury with a mortality rate upto 60 % especially in low-income countries. The present study aimed to determine the clinical characteristics and functional outcomes and the associated factors of surgically treated head trauma patients with ASDH. MethodsBetween January 2018 and January 2021 we identified 140 head trauma patients with ASDH who underwent surgical evacuation in three tertiary hospitals. Epidemiological data were collected; the six-month functional outcome was studied using an extended Glasgow outcome score (EGOS) and associated factors were also studied. Univariate analysis was performed at first, and variables with a P-value of <0.05 were entered into the multivariable logistic regression model. ResultsMale predominance was seen accounting for 87 % and assault was the most common mechanism of injury (35.7 %). Sixty-five (56.5 %) of patients achieved favorable functional recovery (EGOS of 5–8) and 50 (43.5 %) of patients had unfavorable recovery (EGOS of 1–4) after 6 months of follow-up. In multivariate logistic regression models, GCS <5, Pupillary abnormality, hypotension, oxygen saturation <90 at presentation, and hospital-acquired pneumonia were the independent factors associated with unfavorable functional outcomes. ConclusionIn our setup, most of the patients are male from assault injuries. There is still a high rate of unfavorable outcomes in patients with acute subdural hematoma. GCS <5, pupillary abnormality, hypotension and desaturation at presentation, and postoperative hospital-acquired infection are predictors for unfavorable functional outcomes.

Prognosis of Patients Having Post Traumatic Extra Dural Hematoma with and without Lucid Interval

Background: There is limited research in our country on the prognosis of patients with post-traumatic extradural hematoma, particularly in relation to the presence or absence of a lucid interval. Understanding this relationship is vital for effective surgical planning and family counselling. Objective: The study aimed to assess the prognosis of patients with post-traumatic extradural hematoma, focusing on the impact of a lucid interval on patient outcomes. Methods: This retrospective study, approved by the hospital's ethical committee, included 46 patients with post-traumatic extradural hematoma, both with and without a lucid interval. The study variables were age, gender, mechanism of injury, pupillary abnormalities, Glasgow Coma Scale (GCS) score upon admission, and presence of a lucid interval. Patient outcomes at discharge, including mortality, residual disabilities, and functional recovery, were documented. Data analysis was performed using SPSS 23, employing descriptive statistical methods. Results: The average age of patients was 27.04±7.74 years, with the majority (52.2%) aged between 21 and 30 years. Males constituted 84.8% of the study group. Regarding the GCS score, 23.9% of patients scored below 8. The study found that 37.0% of the patients experienced mortality, 23.9% had residual disabilities, and 58.7% achieved functional recovery. Notably, functional recovery was 50.0% in patients who experienced a lucid interval, compared to 90.0% in those who did not. Conclusion: The study concluded that patients with post-traumatic extradural hematoma who present without a lucid interval have a better prognosis than those with a lucid interval. The delay in timely management associated with a lucid interval leads to increased morbidity and mortality.

Outcomes of traumatic brain injury patients with acute epidural and subdural hematoma who underwent burr hole surgery: A two-year study at Kilimanjaro Christian Medical Centre, Tanzania

BackgroundTraumatic brain injury is a leading cause of mortality and morbidity in Africa. Craniotomy is the surgical standard for acute extra-axial hematomas that is not realistic in LMIC due to deficient human and operative resources. Burr hole surgery may be an alternative in resource-limited settings. This study aimed at determining outcomes and factors associated with burr hole surgery as definitive management of traumatic extra-axial hematomas. MethodsHospital-based cross-sectional study of patients with acute traumatic extra-axial hematomas who underwent burr hole surgery. Data were extracted from the patient's medical records after confirmation of the surgery and CT scan findings. The data were entered to SPSS 25 for analysis where a bivariate analysis was done. Results156 participants were enrolled; 149 (95.5 %) were males. The mean age of the participants was 35.33 (SD 15.37) years. The mean arrival GCS was 11.76 ± 3.59. Most participants had mild, followed by severe then moderate (55.8 %, 24.4 %, and 19.9 % respectively) TBI. 118 (75.6 %) participants had good outcomes and the overall in-hospital mortality was 18.6 %. 109 (69.9 %) had epidural hematomas mostly (21 %) in the parietal lobe. 30 (19.2 %) had brain herniation syndromes. Poor outcomes were associated with age above 50 years, severe TBI, motor response <4, abnormal pupil size, other injuries, ICU admission, SDH, midline shift >10 mm, cerebral edema, and brain herniation syndromes. Surgical site infection and hemostasis by packing were associated with a long length of hospital stay. ConclusionBurr hole surgery is still a safe, effective, and simple life-saving procedure in patients with acute hematomas in resource-constrained areas.

Factors Associated With Stroke Mortality in an Urban-Rural Environment: The Case of the MONKOLE Hospital Centre

Background: Stroke is a fatal disease, and knowledge of the factors associated with this mortality in different environments is necessary in order to take appropriate action. This article presents data from a hospital located in an urban-rural setting in Kinshasa: The Monkole hospital centre. Methods: This is a cross-sectional study conducted at Monkole hospital Centre from 01/01/2020 to 31/01/2023 in all patients with a confirmed diagnosis of stroke admitted to intensive care, emergency or internal medicine. Sociodemographic, clinical, paraclinical, therapeutic and outcome data were collected from hospital registers and patient records. Student's t, Anova, Chi-squared or Fischer's exact tests and logistic regression were performed with SPSS 25.0 with p less than 5%. Ethical principles were respected. Results: Of 3,629 patients admitted during the study period, 148 (4%) were admitted for stroke. The mean age was 62.6 years and the predominant sex was male. 51.4% of patients were admitted from home, with the following comorbidities: arterial hypertension, diabetes mellitus and embolism-induced heart disease. Frequent reasons for consultation were: disturbed consciousness, increased blood pressure and convulsions. Frequent physical signs were: disturbed consciousness, increased blood pressure, neurological deficit and pupillary abnormalities. The average time to hospital was 13.6 ± 8.2 hours. The accident was ischaemic in 70.3% and haemorrhagic in 29.7%. Treatment was medical in 100% of cases, with no thrombolysis. Mortality was 11.5% and 36.5% of survivors had moderate to severe functional disability. Advanced age (OR 2.34, 95% CI 1.36-4.04), hypertension (OR 2.19, 95% CI 1.24-3.88) and low socio-economic status (OR 1.81, 95% CI 1.02-3.21) were associated with mortality. Conclusion: Mortality in this series was 11.5%, associated with advanced age, hypertension and low socioeconomic status. Controlling blood pressure and improving living conditions could reduce this mortality

Outcome of Nonoperative Management of Selected Cases of Acute Traumatic Intracranial Hematomas in a Rural Neurosurgical Service of a Developing Country

In resource-limited settings, the standard of care prescribed in developed countries for either operative or nonoperative management of traumatic intracranial hematomas (TICHs) frequently has to be adapted to the economic and infrastructural realities. This study aims to present the outcome of selected cases of TICHs managed nonoperatively without routine intensive care unit admission, repeated cranial computed tomography (CT) scan or intracranial pressure monitoring at a rural neurosurgical service in a developing country. This was a retrospective analysis of a cohort of our patients with cranial CT-confirmed TICHs selected for nonoperative treatment from our prospective head injury (HI) register over a 42-month period. There were 67 patients (51 males) in this study with a mean age of 38.6 (standard deviation, 17.6) years, having mild HI in >half, (55.2%, 37/67) and anisocoria in 22.4% (15/67). Road traffic accident was the most common (50/67, 74.7%) trauma etiology. Isolated acute-subdural hematoma, intracerebral hemorrhage, and epidural hematoma occurred in 29.9%, 25.4%, and 22.4% of the patients respectively. Only 2 of 8 patients in whom intensive care unit admission was deemed necessary could afford admission. Repeat cranial CT scan was requested in 8 patients (8/67, 11.9%); only 5 of these could afford the investigation. The outcome of care was good in 82.1% patients (55/67). Increasing severity of the HI (P<0.01) and presence of pupillary abnormality (P=0.03) were significant predictors of poor outcome. In a Nigerian rural neurosurgery practice, nonoperative management of a well-selected cohort of TICHs was attended by acceptable level of favorable outcome.

Re: Pupil Abnormalities in Orbital Cavernomas: The Pupil Matters Both Preoperatively and Postoperatively.

Re: Pupil Abnormalities in Orbital Cavernomas: The Pupil Matters Both Preoperatively and Postoperatively.

Case Report: Congenital Pseudoacorea in an Ocular Axenfeld-Rieger Syndrome: What is it?

This is a descriptive summary of the case of a patient with Axenfeld-Rieger syndrome associated with a congenital malformation of the iris and consequent pupillary morphological alteration of an atypical characteristic reported. This anomaly is unique in scientific literature and exhibits a peculiarity that we have called pseudoacorea: Hidden pupil. Other associated abnormal clinical findings were posterior embryotoxon, astigmatism, amblyopia, and exotropia. Diagnosis was achieved by instilling ocular mydriatics into the cul-de-sac that revealed this peculiarity. It is necessary to make a differential diagnosis with other pupillary pathologies such as corectopia, acorea and microcoria. Early detection of pathology and surgical management is necessary, since it would lead to a better visual prognosis for both amblyopia and strabismus. Among the malformations of the pupil, we can find polycoria (more than one pupil), dyscoria (abnormal pupil shape), corectopia (abnormal pupil position) and acorea (absence of pupil). In addition, morphologically normal pupils can denote other anomalies such as the microcoria described by Holth in 1923. Acorea is a rare anomaly, congenital or acquired, characterized by an absolute absence of the pupil both at rest and in mydriasis. In our case we prefer to differentiate it and name it pseudoacorea, since although there is a total absence of the pupil at rest thanks to the application of ocular mydriatics, a micropupil with discoric and corectopic characteristics is achieved. It is worth noting that we have not detected in the scientific literature any case described as the one that we will develop here. The case of a patient with Axenfeld-Rieger syndrome associated with a congenital malformation of the iris and consequent atypical pupillary morphological alteration is presented. This anomaly is unique in the scientific literature and presents a peculiarity that we have called pseudoacorea: Hidden pupil. Early detection of pathology and surgical management is necessary, since it would lead to a better visual prognosis for both amblyopia and strabismus.

Factors Predicting Outcome of Surgically Treated Acute Subdural Hematoma

Objective: The study aimed to evaluate operative mortality and prognosis factors in posttraumatic acute subdural hematoma patients. Material &amp; Methods: A prospective cross-sectional study was done in the Department of Neurosurgery, Ayub Teaching Hospital Abbottabad. 82 patients operated for Acute Subdural Hematoma were included in the study. Variables that influence the outcome were recorded. The outcome was measured in terms of mortality. Results: Of 82 patients operated on, 61 were male, and 21 were female. 51 were &lt;40 old years, 21 were aged 41-60, and 7 were over 60. The most common cause is fall from height (47.6%). Cerebral contusion is often associated (28%). Overall mortality: 39.2%. Male mortality: 29.2%, female: 9.7%. Surgery &gt;4 hours post-injury had higher mortality (18.2%) vs. &lt;4 hours (8.5%). 14/43 GCS &lt;8 patients survived, with no deaths when GCS &gt;12. Pupillary abnormalities had higher mortality (31.9%) vs. normal pupils (7.3%). No deaths with hematoma thickness &lt;10mm and only 1 survived with a thickness &gt;16mm. 25/29 died with midline shift &gt;11mm. Conclusion: Prognostic factors for surgically treated traumatic acute subdural hematoma include GCS at presentation, pupils, hematoma thickness, midline shift, and time to surgery. Better outcomes associated with GCS&gt;9, normal pupils, hematoma width &lt;1.5cm, midline shift &lt;1cm, and surgery within 4 hours.

P30 An unusual infective cause of inflammatory arthritis

P30 An unusual infective cause of inflammatory arthritis

Prognostic Factors of Mortality and Functional Outcome for Acute Subdural Hematoma: A Review Article.

Acute subdural hematoma (ASDH) is the most frequent intracranial traumatic lesion requiring surgery in high-income countries. To date, uncertainty remains regarding the odds of mortality or functional outcome of patients with ASDH, regardless of whether they are operated on. This review aims to shed light on the clinical and radiologic factors associated with ASDH outcome. A scoping review was conducted on Medline database from inception to 2023. This review yielded 41 patient series. In the general population, specific clinical (admission Glasgow Coma Scale [GCS], abnormal pupil exam, time to surgery, decompressive craniectomy, raised postoperative intracranial pressure) and radiologic (ASDH thickness, midline shift, thickness/midline shift ratio, uncal herniation, and brain density difference) factors were associated with mortality (grade III). Other clinical (admission GCS, decompressive craniectomy) and radiologic (ASDH volume, thickness/midline shift ratio, uncal herniation, loss of basal cisterns, petechiae, and brain density difference) factors were associated with functional outcome (grade III). In the elderly, only postoperative GCS and midline shift on brain computed tomography were associated with mortality (grade III). Comorbidities, abnormal pupil examination, postoperative GCS, intensive care unit hospitalization, and midline shift were associated with functional outcome (grade III). Based on these factors, the SHE (Subdural Hematoma in the Elderly) and the RASH (Richmond Acute Subdural Hematoma) scores could be used in daily clinical practice. This review has underlined a few supplementary factors of prognostic interest in patients with ASDH, and highlighted two predictive scores that could be used in clinical practice to guide and assist clinicians in surgical indication.

Non-Traumatic Coma in Children- A Review

Coma is defined as the unintentional failure of the patient to open their eyes spontaneously or in response to noise and inability to open for commands or localised painful stimuli with or without the ability to express comprehensible words or language response, whereas the Non traumatic coma is without any injury to the brain, and the Glasgow coma scale below 12. The Non traumatic coma causes due to the infections(tubercular meningitis, bacterial meningitis, encephalitis) and other metabolic conditions ,status epilepticus intracranial bleed, miscellaneous, hypoxic ischemic insults, Electrical shock, shunt dysfunction, Inborn error of metabolism. The monitoring parameters are Heart rate, Respiratory rate and pattern, Blood pressure, Temperature, coma severity using GCS, pupillary size, extra ocular movements, corneal reflex, posture, and motor pattern. The main symptoms are ataxia or weakness, isolated cranial nerve palsy, mild alteration of tone, poor pulse volume, apnea, abnormal pupillary size and reaction, dizziness, Headache, abnormal extra ocular movements absent corneal reflex. Management of non-traumatic coma patients at hospital includes Monitoring of Intracranial pressure, Maintenance of an adequate cerebral perfusion pressure, Management of persistent intracranial hypertension and Monitoring of Electroencephalographic Seizure activity. Infections are the most common cause for the non-traumatic coma in several cases. The pattern of infectious caused are CNS infections &gt; metabolic toxic exposure &gt; encephalitis &gt; Intoxication &gt; hypoxic ischemic insults &gt; Intracranial haemorrhages&gt;miscellaneous&gt;unknown cases. 40% of children are prone to Non traumatic coma per 10000 general population per year.