Pitfall in Pupillometry: Exaggerated Ciliospinal Reflex in a Patient in Barbiturate Coma Mimicking a Nonreactive Pupil
نویسندگان
چکیده
Although a neurological examination is fundamental to the evaluation of comatose patients, it is less reliable in a medically induced coma. A commonly misinterpreted finding in patients in a pentobarbital coma is altered pupillary reactivity secondary to an exaggerated ciliospinal reflex. Recognizing an exaggerated ciliospinal reflex in patients in a pentobarbital coma is important and may prevent unnecessary intervention. We present a patient induced in a pentobarbital coma for the treatment of status epilepticus who exhibited a nonreactive pupil secondary to an exaggerated ciliospinal reflex confirmed by pupillometry. We also discuss the anatomy of the ciliospinal reflex and literature regarding its clinical relevance.
منابع مشابه
Reliability of standard pupillometry practice in neurocritical care: an observational, double-blinded study
BACKGROUND In critical care units, pupil examination is an important clinical parameter for patient monitoring. Current practice is to use a penlight to observe the pupillary light reflex. The result seems to be a subjective measurement, with low precision and reproducibility. Several quantitative pupillometer devices are now available, although their use is primarily restricted to the research...
متن کاملComa Blisters in the Setting of Quetiapine Overdose: Case Report and Review of Literature
Background: Skin lesions and blistering in the overdose patient, most notably associated with barbiturate overdoses, are commonly referred to as coma blisters, ‘barb blisters’, or ‘barb burns’. We present a patient who was noted to have skin lesions including bullae and blistering following a prolonged coma after quetiapine overdose. Case report: A 27 year old male presented to our institution ...
متن کاملLarge and small: a telltale sign of acute pontomesencephalic injury.
An 85-year-old woman was found comatose. Her right pupil was 2 mm and reactive while the left pupil was 6.5 mm and nonreactive (figure, A). Oculocephalic and corneal reflexes were absent, the cough reflex was preserved, and there was spontaneous bilateral decerebrate posturing. Traditional teaching indicates that midbrain lesions cause fixed, midposition pupils while pontine lesions cause pinpo...
متن کاملThe Use of Automated Pupillometry in Critical Care.
The neurologic examination (neuroexamination) is one of the most powerful tools available to nurses and physicians caring for patients with neurologic or neurosurgical illness. Assessing cranial nerve function is one of the most vital components of the neuroexamination. The pupillary light reflex helps to evaluate the status of the second and third cranial nerves and is one of the most well-kno...
متن کاملThe fear-inhibited light reflex: importance of the anticipation of an aversive event.
RATIONALE It has been shown previously that the amplitude of the pupillary light reflex response decreases when subjects anticipate an aversive stimulus (i.e. electric shock), compared to periods when subjects are resting ('fear-inhibited light reflex'). OBJECTIVE To compare the effects of the anticipation of an electric shock (putative aversive event) and of an acoustic stimulus (putative ne...
متن کامل