Scholarlink

Background <p>Hydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH) is common, but bedside markers of its physiological burden are limited. Quantitative pupillometry (QP) is objective and fast; whether it mirrors hydrocephalus severity is uncertain.</p> Methods <p>Single-center cohort of adults with aSAH undergoing ventriculoperitoneal shunting (<i>n</i> = 17). Automated infrared pupillometry (NPi-200) was performed the day before surgery and on post-op day 1, recording Neurological Pupil index (NPi) and constriction/dilation velocities (CV/DV) as overall values (mean of both eyes) and inter-eye asymmetry (|OD–OS|). Pre-op CT markers were combined into a standardized Hydrocephalus Severity Score (HSS; higher=worse).</p> Results <p>Mean pre-op NPi was 3.81 ± 0.69 and post-op 4.03 ± 0.66; median ΔNPi = + 0.13 (Wilcoxon <i>p</i> = 0.141). Responders (ΔNPi ≥ + 0.5) were 5/14 (35.7%). Cross-sectionally, overall values did not mirror ventricular size: NPi vs. HSS (ρ = 0.37, <i>p</i> = 0.141, q = 0.423) and NPi vs. Evans index (EI) (ρ = 0.09, <i>p</i> = 0.735, q = 0.735) were non-significant; CV/DV vs. HSS were likewise neutral. In contrast, inter-eye CV asymmetry correlated with HSS (ρ = 0.68, <i>p</i> = 0.006, q = 0.017; <i>n</i> = 16) and trended with Evans (ρ = 0.49, <i>p</i> = 0.054, q = 0.161). In age/sex-adjusted models, no radiologic metric, including HSS, reliably explained pathological NPi (&lt; 3).</p> Conclusions <p>In shunt-dependent aSAH hydrocephalus, pattern matters more than absolute value. Absolute NPi and mean velocities did not reflect ventricular size, whereas inter-eye constriction-velocity asymmetry captured composite radiologic burden, consistent with lateralized parasympathetic stress. Around shunt placement, QP behaved as a dynamic biomarker, revealing patient-level gains despite flat cohort averages. Findings support trend- and asymmetry-based pupillometry to complement imaging for CSF-pathway reassessment and early post-shunt surveillance, warranting prospective validation.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Quantitative pupillometry as a sensitive tool for detecting hydrocephalus-related physiologic burden after aSAH: a prospective feasibility study

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年3月3日

查看全文
  • Jonas Lin,
  • Dorothea Mitschang,
  • Viktoriya Sydorenko,
  • Alexander Younsi,
  • Ahmed El Damaty,
  • Martin Dugas,
  • Sandro M. Krieg,
  • Pavlina Lenga

摘要

Background

Hydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH) is common, but bedside markers of its physiological burden are limited. Quantitative pupillometry (QP) is objective and fast; whether it mirrors hydrocephalus severity is uncertain.

Methods

Single-center cohort of adults with aSAH undergoing ventriculoperitoneal shunting (n = 17). Automated infrared pupillometry (NPi-200) was performed the day before surgery and on post-op day 1, recording Neurological Pupil index (NPi) and constriction/dilation velocities (CV/DV) as overall values (mean of both eyes) and inter-eye asymmetry (|OD–OS|). Pre-op CT markers were combined into a standardized Hydrocephalus Severity Score (HSS; higher=worse).

Results

Mean pre-op NPi was 3.81 ± 0.69 and post-op 4.03 ± 0.66; median ΔNPi = + 0.13 (Wilcoxon p = 0.141). Responders (ΔNPi ≥ + 0.5) were 5/14 (35.7%). Cross-sectionally, overall values did not mirror ventricular size: NPi vs. HSS (ρ = 0.37, p = 0.141, q = 0.423) and NPi vs. Evans index (EI) (ρ = 0.09, p = 0.735, q = 0.735) were non-significant; CV/DV vs. HSS were likewise neutral. In contrast, inter-eye CV asymmetry correlated with HSS (ρ = 0.68, p = 0.006, q = 0.017; n = 16) and trended with Evans (ρ = 0.49, p = 0.054, q = 0.161). In age/sex-adjusted models, no radiologic metric, including HSS, reliably explained pathological NPi (< 3).

Conclusions

In shunt-dependent aSAH hydrocephalus, pattern matters more than absolute value. Absolute NPi and mean velocities did not reflect ventricular size, whereas inter-eye constriction-velocity asymmetry captured composite radiologic burden, consistent with lateralized parasympathetic stress. Around shunt placement, QP behaved as a dynamic biomarker, revealing patient-level gains despite flat cohort averages. Findings support trend- and asymmetry-based pupillometry to complement imaging for CSF-pathway reassessment and early post-shunt surveillance, warranting prospective validation.