12/10/2023 0 Comments Anisocoria meaning![]() A total of 708 men and women between the ages of 20–69 years who did not have history of ophthalmologic or neurological disease other than refractive error were included after obtaining informed consent. This prospective study was approved by the Ethics committee of the Institutional Review Board (IRB no: 7935 12 th August, 2013). We, therefore, aimed to study the prevalence of physiological anisocoria in the Indian population and also to evaluate the accuracy of clinical assessment of anisocoria employed in routine bedside examination. Keeping in mind that roughly a fifth of the population may have simple anisocoria at any given point in time, the degree of importance a neurosurgeon gives to the clinical finding of anisocoria may need to be questioned. Decisions to repeat computerized tomography (CT) or magnetic resonance imaging (MRI) scans and occasionally even to operate may be made depending on pupil size. This is especially true in patients who are being sedated and ventilated since the Glasgow Coma Scale (GCS) score can no longer be used to monitor their neurological status. In patients with traumatic brain injury, large mass lesions, and malignant infarcts, the finding of anisocoria may be the first sign of lateral transtentorial herniation of the brain and subsequent permanent brainstem injury. Īssessment of the pupils is part of the routine neurological assessment. in 1987 reported the prevalence of a physiological anisocoria to be 19%, while examining subjects at different times of the day. The occurrence of anisocoria without any underlying pathology is called physiological or simple anisocoria. Available from: Īnisocoria has been defined as a difference in pupillary diameter of more than 0.3 mm. The Prevalence of Physiological Anisocoria and its Clinical Significance - A Neurosurgical Perspective. How to cite this URL: George AS, Abraham AP, Nair S, Joseph M. How to cite this article: George AS, Abraham AP, Nair S, Joseph M. The sensitivity of clinical examination in detecting early anisocoria is poor. Key Message: The nearly 14% incidence of physiological anisocoria must be kept in mind while assessing the pupils of neurosurgical patients. Keywords: Anisocoria, neurosurgery, physiological, simple Patients at risk of developing uncal herniation may, therefore, benefit from routine bedside pupillary assessment with a portable device such as a pupillometer. With a prevalence of anisocoria of 13.7%, the positive predictive value was 0.46, and the negative predictive value was 0.91.Ĭonclusions: The prevalence of physiological anisocoria was 13.7%, which is less than what has previously been reported. The clinical measurement of anisocoria, therefore, showed a specificity of 0.91 and a sensitivity of 0.46. Ninety-seven subjects (13.7%) also had anisocoria on clinical examination, however, only 45 of them had measured anisocoria. Ninety-seven (13.7%) had measured anisocoria on photography. The average pupillary diameter of the subjects was 4.99 mm. Results: Of the 708 subjects, 361 (51%) were males. A difference in pupillary size of 0.4 mm or more was considered anisocoria. This was followed by photography of the subjects' pupils using a digital camera secured on a tripod at a fixed distance from the subject's face. In a closed room with uniform ambient lighting, the subjects' pupils were examined clinically and the presence or absence of anisocoria was recorded. Materials and Methods: A total of 708 voluntary subjects between the ages of 20–69 years who had no history of ophthalmologic or neurological disease other than refractive error were included in the study. Aim: We aimed to estimate the prevalence of physiological anisocoria and also evaluate the accuracy of clinical assessment of anisocoria employed in routine bedside examination.
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