Key result
In patients with stable large hemispheric strokes, maximum pupil size was significantly larger at 4 AM compared to 8 PM (right 3.59 vs 3.21 mm, P<0.001; left 3.51 vs 3.18 mm, P<0.001).
Why the study?
This study investigated the impact of diurnal variation on quantitative pupillary reactivity in stable patients with large hemispheric strokes.
Does diurnal variation impact quantitative pupillary reactivity in stable patients with large hemispheric strokes?
Observational (n=35)
Yes
Does diurnal variation impact quantitative pupillary reactivity in stable patients with large hemispheric strokes?
Absolute Event Rate: 3.59% vs 3.21%
p-value: p=<0.001
Pupillary dynamics demonstrate significant diurnal variations within normal ranges in stable patients with large hemispheric strokes, which should be considered when interpreting pupillometry.
May necessitate time-standardized pupil exams in stroke monitoring; leaves open prognostic relevance.
This study investigated the impact of diurnal variation on quantitative pupillary reactivity in stable patients with large hemispheric strokes. We included 35 patients with large hemispheric stroke without neurological worsening. Quantitative pupillometry was performed every 4 h. Pupillometer values for pupil size, percentage of constriction (%CH), constriction velocity (CV), dilation velocity (DV), and neurological pupil index (NPi) were collected. We evaluated changes in PLR parameters over time using linear mixed model analysis. Among the included patients (n = 35), 951 pupillometer measurements were analyzed. Significant diurnal variations were observed in pupil maximum size, %CH, CV, and DV at 4 AM compared with values at 8 PM. At 4 AM, patients had a significantly larger pupil (right [Rt] 3.59 vs 3.21 mm, P < 0.001; left [Lt] 3.51 vs 3.18 mm, P < 0.001) and higher %CH (Rt 31.48 vs 25.72, P < 0.001; Lt 31.42 vs 24.98, P < 0.001), CV (Rt 1.97 vs 1.68 mm/s, P < 0.001; Lt 1.98 vs 1.65 mm/s, P < 0.001), and DV (Rt 0.97 vs 0.84 mm/s, P < 0.001; Lt 0.94 vs 0.82 mm/s, P = 0.001). Pupillary dynamics demonstrated diurnal variations over 24 h within normal ranges in large hemispheric strokes without neurological worsening.
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Kim et al. (2022) conducted an observational in Large hemispheric strokes (n=35). Time of day (4 AM) vs. Time of day (8 PM baseline) was evaluated on Maximum pupil size (right eye) (p=<0.001). In patients with stable large hemispheric strokes, maximum pupil size was significantly larger at 4 AM compared to 8 PM (right 3.59 vs 3.21 mm, P<0.001; left 3.51 vs 3.18 mm, P<0.001).
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