The localizing value of asymmetry in pupillary size in severe head injury: relation to lesion type and location.

Abstract:

:Reliable Assessment of the probability that a head injury patient harbors a surgical intracranial lesion is critical to both triage and treatment. The authors analyzed data from 608 patients with severe head injuries (Glasgow Coma Scale score, < or = 8) in the Traumatic Coma Data Bank to assess the reliability of pupillary asymmetry in predicting the presence and location of an intracranial mass lesion. Of 210 patients with pupillary asymmetry of > or = 1 mm, 63 (30%) had intracranial mass lesions, 52 (25%) of which were extra-axial in location, 38 (73%) of these located ipsilateral to the larger pupil. Of 51 patients with asymmetry of > or = 3 mm, 22 (43%) had intracranial mass lesions, 18 (35%) of which were extra-axial in location, 14 (64%) of these located ipsilateral to the larger pupil. For both asymmetry categories, strong interactions were found with age and mechanism of injury, the highest incidence of extra-axial lesions occurring in older patients injured other than as occupants of motor vehicles. The authors developed regression equations that provide a graphic means to predict the presence of an intracranial hematoma using data on pupillary asymmetry, age, and mechanism of injury. This predictive model, interpreted in a hospital- and patient-specific fashion, should be of significant use in directing triage, activating diagnostic and therapeutic resources, and evaluating the utility of exploratory trephination.

journal_name

Neurosurgery

journal_title

Neurosurgery

authors

Chesnut RM,Gautille T,Blunt BA,Klauber MR,Marshall LE

doi

10.1227/00006123-199405000-00008

subject

Has Abstract

pub_date

1994-05-01 00:00:00

pages

840-5; discussion 845-6

issue

5

eissn

0148-396X

issn

1524-4040

journal_volume

34

pub_type

杂志文章
  • Anatomoradiological landmarks for accuracy of radiofrequency thermorhizotomy in the treatment of trigeminal neuralgia.

    abstract:OBJECTIVE:The correct positioning of the electrode is of prime importance for effectiveness and selectivity of percutaneous trigeminal radiofrequency thermorhizotomy (RF-TR) for the treatment of trigeminal neuralgia (TN). The aim of our study was to establish some anatomoradiological landmarks for the purpose of accura...

    journal_title:Neurosurgery

    pub_type: 杂志文章,随机对照试验

    doi:10.1227/01.neu.0000335027.00650.83

    authors: Tatli M,Sindou M

    更新日期:2008-07-01 00:00:00

  • Predicting delayed ischemic deficits after aneurysmal subarachnoid hemorrhage using a transient hyperemic response test of cerebral autoregulation.

    abstract:OBJECTIVE:To assess whether the development of delayed ischemic deficits (DIDs) after aneurysmal subarachnoid hemorrhage can be predicted using transcranial Doppler ultrasonography and the transient hyperemic response test (THRT). METHODS:An increase in the middle cerebral artery peak flow velocity (FV) of more than 9...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1097/00006123-200010000-00004

    authors: Lam JM,Smielewski P,Czosnyka M,Pickard JD,Kirkpatrick PJ

    更新日期:2000-10-01 00:00:00

  • Predictors of neurosurgical career choice among residents and residency applicants.

    abstract:OBJECTIVE:Medical students applying for neurosurgery residency positions almost all aspire to become academic neurosurgeons. However, most graduates of neurosurgery residency programs ultimately follow careers in private practice. We hypothesized that there might be factors in a resident's application, interviews, or p...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1227/01.NEU.0000255445.51989.33

    authors: Lawton MT,Narvid J,Quiñones-Hinojosa A

    更新日期:2007-05-01 00:00:00

  • Brief Electrical Stimulation Promotes Nerve Regeneration Following Experimental In-Continuity Nerve Injury.

    abstract:BACKGROUND:Brief electrical stimulation (ES) therapy to the nerve may improve outcome in lacerated, repaired nerves. However, most human nerve injuries leave the nerve in continuity with variable and often poor functional recovery from incomplete axon regeneration and reinnervation. OBJECTIVE:To evaluate the effect of...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1093/neuros/nyy221

    authors: Shapira Y,Sammons V,Forden J,Guo GF,Kipp A,Girgulis J,Mishra T,de Villers Alant JD,Midha R

    更新日期:2019-07-01 00:00:00

  • Comparison of the mini-open versus laparoscopic approach for anterior lumbar interbody fusion: a retrospective review.

    abstract:OBJECTIVE:The anterior lumbar interbody fusion (ALIF) procedure has become an accepted fusion technique for treating patients with degenerative disorders of the lumbar spine. Many consider laparoscopic ALIF to be the least invasive approach. A modification of the open laparotomy--the "mini-open" approach--is an attract...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1097/00006123-200207000-00015

    authors: Kaiser MG,Haid RW Jr,Subach BR,Miller JS,Smith CD,Rodts GE Jr

    更新日期:2002-07-01 00:00:00

  • External validation of the international mission for prognosis and analysis of clinical trials model and the role of markers of coagulation.

    abstract:BACKGROUND:Markers of coagulation have shown to have important value in predicting traumatic brain injury outcome. OBJECTIVE:To externally validate and investigate the role of markers of coagulation for outcome prediction by using the International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) model w...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1227/01.neu.0000430326.40763.ec

    authors: Raj R,Siironen J,Kivisaari R,Hernesniemi J,Tanskanen P,Handolin L,Skrifvars MB

    更新日期:2013-08-01 00:00:00

  • Perioperative fever and outcome in surgical patients with aneurysmal subarachnoid hemorrhage.

    abstract:OBJECTIVE:We examined the incidence of perioperative fever and its relationship to outcome among patients enrolled in the Intraoperative Hypothermia for Aneurysm Surgery Trial. METHODS:One thousand patients with initial World Federation of Neurological Surgeons grades of I to III undergoing clipping of intracranial an...

    journal_title:Neurosurgery

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1227/01.NEU.0000341903.11527.2F

    authors: Todd MM,Hindman BJ,Clarke WR,Torner JC,Weeks JB,Bayman EO,Shi Q,Spofford CM,IHAST Investigators.

    更新日期:2009-05-01 00:00:00

  • The time course of myosin light-chain phosphorylation in blood-induced vasospasm.

    abstract::The phosphorylation of an M(r) 20,000 myosin light chain (MLC20) promotes the generation of contractile force through actin-myosin adenosine triphosphatase in most agonist-mediated vascular smooth muscle cell contraction. However, the role of calcium-mediated contractile processes in sustained arterial narrowing after...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1227/00006123-199506000-00018

    authors: Harada T,Seto M,Sasaki Y,London S,Luo Z,Mayberg M

    更新日期:1995-06-01 00:00:00

  • Temporal lobe arteriovenous malformations: surgical outcomes with a focus on visual field defects and epilepsy.

    abstract:BACKGROUND:Temporal lobe arteriovenous malformations (AVMs) represent a subgroup of intracranial AVMs with particular characteristics and management issues. OBJECTIVE:To characterize the surgical outcomes of temporal lobe AVMs with emphasis on visual field deficits (VFDs) and seizures. METHODS:Between 1992 and 2008, ...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1227/NEU.0000000000000122

    authors: Lopez-Ojeda P,Labib M,Burneo J,Lownie SP

    更新日期:2013-11-01 00:00:00

  • Radiosurgery in the treatment of malignant gliomas: the University of Florida experience.

    abstract:OBJECTIVE:To review a single-institution's 12-year experience of treating malignant gliomas with linear accelerator-based radiosurgery. METHODS:One hundred patients were treated for malignant gliomas at the University of Florida between May 1, 1989, and June 12, 2002. Patient variables were entered into a radiosurgery...

    journal_title:Neurosurgery

    pub_type: 临床试验,杂志文章

    doi:10.1227/01.neu.0000170560.13251.99

    authors: Ulm AJ 3rd,Friedman WA,Bradshaw P,Foote KD,Bova FJ

    更新日期:2005-09-01 00:00:00

  • Phrenology in the science and culture of the 19th century.

    abstract::In the last decade of the 18th century, Franz Joseph Gall of Vienna invented a combination of physiognomy and brain localization that he originally called "craniology" (the science of the head) and later called "organology" (the science of the organs of the brain). Between 1800 and 1812, he worked with Johann Christop...

    journal_title:Neurosurgery

    pub_type: 传,历史文章,杂志文章

    doi:10.1227/00006123-199510000-00025

    authors: Greenblatt SH

    更新日期:1995-10-01 00:00:00

  • Challenges in contemporary academic neurosurgery.

    abstract::Traditionally, the ideal academic neurosurgeon has been a "quadruple threat," with excellence in clinical work, teaching, research, and administration. This tradition was best exemplified in Harvey Cushing, who developed the field of neurosurgery 90 years ago. This paradigm will probably have to change as academic neu...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1227/01.NEU.0000197139.61412.36

    authors: Black PM

    更新日期:2006-03-01 00:00:00

  • Successful laser-assisted excision of a metastatic midbrain tumor.

    abstract::Metastatic lesions to the midbrain are rare. They are found in 1 to 3% of autopsy series of solitary brain metastases. The consensus of opinion in the current literature is that they are inoperable lesions and should be treated by radiation therapy alone. This is the first case report of a completely excised metastati...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1227/00006123-198606000-00022

    authors: Tobler WD,Sawaya R,Tew JM Jr

    更新日期:1986-06-01 00:00:00

  • Aggressive papillary middle ear tumors: a report of two cases with review of the literature.

    abstract::Adenomatous tumors of the middle ear are rare, with only approximately 100 cases reported. A distinct subclass of this tumor demonstrates microscopic papillary architecture and has a propensity to erode the petrous bone and extend intracranially. The term "aggressive papillary middle ear tumor" has recently been propo...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1227/00006123-199409000-00018

    authors: Polinsky MN,Brunberg JA,McKeever PE,Sandler HM,Telian S,Ross D

    更新日期:1994-09-01 00:00:00

  • Hemangioma calcificans in the fourth ventricle.

    abstract::A case of hemangioma calcificans in the 4th ventricle is reported. Skull x-ray films demonstrated a dense calcification in the posterior fossa. Computed tomography disclosed a hyperdense mass in the 4th ventricle. The clinical picture was of increased intracranial pressure due to obstructive hydrocephalus. An hemangio...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1227/00006123-198406000-00016

    authors: Kobayashi H,Kawano H,Ito H,Hayashi M,Yamamoto S

    更新日期:1984-06-01 00:00:00

  • Emergency neurosurgical care solutions: acute care surgery, regionalization, and the neurosurgeon: results of the 2008 CNS consensus session.

    abstract:OBJECTIVE:Organized general surgery has recently proposed creation of a new acute care surgery subspecialty to include emergency care of basic neurosurgical and orthopedic surgical problems. Little is known about neurosurgical attitudes toward this proposal and alternative methods of improving access to emergency neuro...

    journal_title:Neurosurgery

    pub_type: 共识发展会议,杂志文章

    doi:10.1227/NEU.0b013e318209cde0

    authors: Byrne RW,Bagan BT,Bingaman W,Anderson VC,Selden NR

    更新日期:2011-04-01 00:00:00

  • Late magnetic resonance imaging related to neurobehavioral functioning after aneurysmal subarachnoid hemorrhage.

    abstract::Twenty patients who underwent early aneurysm surgery--that is, surgery within 72 hours after rupture--underwent further follow-up examination including magnetic resonance imaging (MRI) of the brain and a comprehensive neuropsychological assessment. Significant statistical correlation between tissue loss as seen on a l...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1097/00006123-198909000-00012

    authors: Romner B,Sonesson B,Ljunggren B,Brandt L,Säveland H,Holtås S

    更新日期:1989-09-01 00:00:00

  • Posterior reduction and fixation of an unstable Jefferson fracture with C1 lateral mass screws, C2 isthmus screws, and crosslink fixation: technical case report.

    abstract:OBJECTIVE:We sought to describe a modified technique for the reduction and stabilization of unstable Jefferson fractures. CLINICAL PRESENTATION:We present the case of an isolated unstable Jefferson fracture in a 33-year-old woman. The patient was the victim of a motor vehicle accident. Her neurological examination was...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1227/01.neu.0000335022.91240.c9

    authors: Tessitore E,Momjian A,Payer M

    更新日期:2008-07-01 00:00:00

  • Brain stem auditory evoked potentials in posterior circulation surgery.

    abstract::The objectives of this study were to evaluate the use of brain stem auditory evoked potentials (BAEPs) in 10 adult patients with vascular disorders of the posterior circulation that were treated surgically and to compare the BAEPs with the neurological findings. The vascular lesions included basilar artery stenosis in...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1227/00006123-198305000-00003

    authors: Little JR,Lesser RP,Lueders H,Furlan AJ

    更新日期:1983-05-01 00:00:00

  • Feasibility, safety, and periprocedural complications associated with endovascular treatment of selected ruptured aneurysms under conscious sedation and local anesthesia.

    abstract:BACKGROUND:Endovascular coil embolization of ruptured aneurysms is performed under general anesthesia at most centers for perceived improved image quality and patient safety. OBJECTIVE:To report the feasibility of and outcomes associated with endovascular treatment of subarachnoid hemorrhage (SAH) patients with ruptur...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1227/NEU.0b013e31827b9183

    authors: Kan P,Jahshan S,Yashar P,Orion D,Webb S,Siddiqui AH,Hopkins LN,Levy EI

    更新日期:2013-02-01 00:00:00

  • Therapeutic modalities for the management of cerebral vasospasm: timing of endovascular options.

    abstract:OBJECTIVES:To determine if a window of time could be defined during which angioplasty would be most effective in reversing neurological decline and ultimately improving outcome. METHODS:Of a group of 466 patients, 93 underwent endovascular management of clinical vasospasm that was medically refractory. Eighty-four of ...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1097/00006123-199905000-00022

    authors: Rosenwasser RH,Armonda RA,Thomas JE,Benitez RP,Gannon PM,Harrop J

    更新日期:1999-05-01 00:00:00

  • Unusual angiographic changes in a dissecting aneurysm of the basilar artery: case report.

    abstract::A patient with unusual angiographic changes of a dissecting aneurysm of the basilar artery is presented. Initial angiography and magnetic resonance imaging revealed a typical dissecting aneurysm. However, a follow-up study demonstrated a saccular aneurysmal dilatation of the proximal part of the dissection. The import...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1227/00006123-199402000-00022

    authors: Takagi M,Hirata K,Fujitsu K,Yamamoto I

    更新日期:1994-02-01 00:00:00

  • Ruptured arteriovenous malformation in the auditory nerve: technical case report.

    abstract:OBJECTIVE AND IMPORTANCE:Arteriovenous malformations in the cranial nerves are very rare, and only one case has been reported in the literature. To our knowledge, this is the first case report of an arteriovenous malformation in the auditory nerve. CLINICAL PRESENTATION:A 30-year-old woman presented with a subarachnoi...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1227/01.neu.0000159720.61145.6e

    authors: Oya S,Matsui T,Asai A

    更新日期:2005-06-01 00:00:00

  • Surgical expertise in neurosurgery: integrating theory into practice.

    abstract::: The development of technical skills is a major goal of any neurosurgical training program. Residency programs in North America are focused on achieving an adequate level of training to produce technically competent surgeons. The training requirements and educational environments needed to produce expert surgeons are...

    journal_title:Neurosurgery

    pub_type: 杂志文章,评审

    doi:10.1227/NEU.0000000000000115

    authors: Gélinas-Phaneuf N,Del Maestro RF

    更新日期:2013-10-01 00:00:00

  • Past, Present, and Future of Neurosurgery in Uganda.

    abstract::Neurosurgery in Uganda was virtually non-existent up until late 1960s. This changed when Dr. Jovan Kiryabwire spearheaded development of a neurosurgical unit at Mulago Hospital in Kampala. His work ethic and vision set the stage for rapid expansion of neurosurgical care in Uganda.At the beginning of the 2000s, Uganda ...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1093/neuros/nyw159

    authors: Haglund MM,Warf B,Fuller A,Freischlag K,Muhumuza M,Ssenyonjo H,Mukasa J,Mugamba J,Kiryabwire J

    更新日期:2017-04-01 00:00:00

  • Isolated injection injury to the posterior femoral cutaneous nerve.

    abstract::The sciatic nerve is by far the most common nerve accidentally injured during intramuscular injection. Despite its close proximity to the sciatic nerve, however, injury to the posterior femoral cutaneous nerve is apparently quite rare. In this report, clinical features of a patient with isolated injection injury to th...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1097/00006123-198911000-00027

    authors: Iyer VG,Shields CB

    更新日期:1989-11-01 00:00:00

  • Cerebral salt wasting after pituitary exploration and biopsy: case report.

    abstract::We report a case of hyponatremia associated with volume depletion after pituitary exploration and biopsy. The presence of clinical dehydration precluded diagnosis of the syndrome of inappropriate secretion of antidiuretic hormone. The absence of a hypoadrenal state and the patient's response to volume reexpansion were...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1227/00006123-198604000-00015

    authors: Andrews BT,Fitzgerald PA,Tyrell JB,Wilson CB

    更新日期:1986-04-01 00:00:00

  • Vertebral artery-posteroinferior cerebellar artery aneurysms: clinical and lower cranial nerve outcomes in 52 patients.

    abstract:OBJECTIVE:To identify factors predictive of postoperative lower cranial nerve palsy (LCNP) among patients undergoing surgery for vertebral artery (VA)- posteroinferior cerebellar artery (PICA) aneurysms. The natural history of this LCNP is defined, and its effect on postoperative patient course is analyzed. No similar ...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:

    authors: Al-khayat H,Al-Khayat H,Beshay J,Manner D,White J

    更新日期:2005-01-01 00:00:00

  • Somatosensory evoked potential changes in neuroendovascular procedures: incidence and association with clinical outcome in 873 patients.

    abstract:BACKGROUND:Neurophysiological monitoring is routinely used during neurosurgical procedures. Use of neurophysiological monitoring has extended to neuroendovascular procedures, but evidence of its impact on clinical outcome in this arena is limited. OBJECTIVE:To report the incidence of significant intraoperative somatos...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1227/NEU.0000000000000510

    authors: Phillips JL,Chalouhi N,Jabbour P,Starke RM,Bovenzi CD,Rosenwasser RH,Wilent WB,Romo VM,Tjoumakaris SI

    更新日期:2014-11-01 00:00:00

  • Symptomatic spinal epidural lipomatosis after local epidural corticosteroid injections: case report.

    abstract:OBJECTIVE AND IMPORTANCE:Spinal epidural lipomatosis, which causes symptomatic compression of neural elements, is a well known but uncommon complication of Cushing's syndrome. Spinal epidural lipomatosis has been reported frequently in association with chronic systemic corticosteroid therapy, but thus far only one case...

    journal_title:Neurosurgery

    pub_type: 杂志文章

    doi:10.1097/00006123-199907000-00037

    authors: Sandberg DI,Lavyne MH

    更新日期:1999-07-01 00:00:00