J Neurocrit Care.  2023 Dec;16(2):69-76. 10.18700/jnc.230030.

Diurnal variation in quantitative pupillary reactivity in large hemispheric stroke

• Kim TJ
• Lee JS
• Park SH
• Ko SB

• KMID: 2549483
• DOI: http://doi.org/10.18700/jnc.230030

Abstract

Background
Pupillary light reflex (PLR) assessment is an important neurological examination reflecting neurological deterioration in severe stroke cases. This study investigated the impact of diurnal variation in the PLR using quantitative pupillometry in stable patients with large hemispheric stroke.
Methods
We included 35 patients with large hemispheric stroke without neurological worsening, who were admitted to the neurological intensive care unit between April 2017 and November 2021. Quantitative pupillometry was performed every 4 hours. Pupillometer parameters of maximum pupil size, percentage of constriction (%CH), latency (LAT), constriction velocity (CV), dilation velocity (DV), maximum constriction velocity (MCV), and neurological pupil index (NPi) score were recorded. We evaluated changes in the pupillometer parameters over time using linear mixed model analysis.
Results
The diurnal variations revealed that the following parameters were significantly higher at 04:00 than at 20:00: maximum pupil size (right [Rt]: 3.59 vs. 3.21 mm, P<0.001; left [Lt]: 3.51 vs. 3.18 mm, P<0.001), %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/sec, P<0.001; Lt: 1.98 vs. 1.65 mm/sec, P<0.001), and DV (Rt: 0.97 vs. 0.84 mm/sec, P<0.001; Lt: 0.94 vs. 0.82 mm/sec, P=0.001). However, no significant diurnal variations were observed in the NPi values.
Conclusion
Pupillary dynamics based on quantitative pupillometer parameters, including the NPi, demonstrated diurnal variations over 24 hours in large hemispheric stroke patients without neurological worsening. However, all changes in the pupillometer parameters were within normal ranges.

Keyword

Abnormal pupillary function; Rhythm; Diurnal; Acute stroke

Figure

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  Fig. 1. Variations in the pupillometer parameters over 24 hours: (A) maximum pupil size, (B) percentage of constriction (%CH), (C) latency (LAT), (D) constriction velocity (CV), (E) maximum constriction velocity (MCV), (F) dilation velocity (DV), (G) neurological pupil index (NPi). Quantitative pupillometry was performed every 4 hours using the NPi-100 pupillometer. Significant diurnal variations are observed in the maximum pupil size, %CH, CV, MCV, and DV during the 24-hour period. The pupillometer parameters, including maximum pupil size, %CH, CV, MCV, and DV show a gradual increase after 20:00 (baseline); the values recorded at 04:00 AM are the highest, whereas those recorded at 20:00 are the lowest. P-value in right (Rt) and left (Lt): P for linear trend. *P<0.05.

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