![]() ![]() Pupillometer (NeurOptics, IrvineĬA, USA) exam demonstrated a decrease in Neurological Pupil index (NPi) on the right fromĤ.4 to 0 and increased diameter from 2.5 to 4.8 mm (left pupil: NPi 3.6, diameter 2.4 mm). On HD 8, his right pupil became dilated and unreactive. ContinuousĮlectroencephalographic monitoring showed no evidence of seizures. On HD 7, he became drowsierīut followed commands and remained easily arousable. Right-to-left midline shift from 4 to 7 mm ( Figure 1C) and right uncal herniation ( Figure 1D). Hospital day (HD) 4 demonstrated blossoming of contusions and worsening edema with increased Midline shift, with mildly increased right-to-left subfalcine herniation and similarĮffacement of the right perimesencephalic cistern compared to prior (E and F).įor the next 5 days, the patient’s neurologic exam remained stable, although head CT on Increasing edema around his right frontal contusion, now with 9 mm of right-to-left Head computed tomography obtained after right NPi became 0 showing Mental status showing worsening bifrontal edema with 7 mm of right-to-left midline Repeat head computed tomography obtained due to decreased Head computed tomography at the time of presentation showing bifrontal contusions and Impeding herniation due to intraparenchymal contusions, highlighting that any pupillaryĬhange warrants prompt work-up and intervention. Without deterioration of consciousness has been described due to traumatic subdural andĮpidural hematomas, we report this unusual constellation as a sign of rising ICP and His pupil became reactive 5 hours after surgery. We performed an emergent right-sided decompressive hemicraniectomy Midline shift and interval increase in subfalcine herniation related to increased Head computed tomography showed worsening Produced no improvement in his pupillary exam. Corneal reflexes were intact bilaterally. Gaze was dysconjugate with impaired vertical excursion and inability to fully abduct to Heĭescribed complete loss of vision and could not identify objects or count fingers. The patient was drowsy,Īrousable to tactile stimuli, answering questions, oriented to place and time, followingĬommands on his right side, maintaining Glasgow Coma Scale of 14 (E4, V5, M6). On hospital dayĨ, his right pupil became fixed (NPi 0) and dilated (4.8 mm). With bifrontal contusions and right frontal intraparenchymal hemorrhage. History of hypertension and diabetes mellitus type II presented after being assaulted, While maintaining consciousness and the ability to communicate. We describe an exceptional case ofĪ patient with bifrontal contusions who developed worsening edema and a unilaterally FDP Typically experience a deterioration in consciousness. The inferior orbital fissure transmits CN V-2 and the infraorbital artery and vein.Patients with fixed and dilated pupils (FDPs) due to rising intracranial pressure (ICP) Communicates with the infratemporal and pterygopalatine fossae. An opening between the greater and lesser wings of the sphenoid bone that transmits the oculomotor, trochlear, ophthalmic, and abducens nerves (CNN III, IV, V-1, and VI, respectively), and the ophthalmic veins. Transmits the optic nerve (CN II) and the ophthalmic artery. Drains tears from the eye to the inferior meatus in the nasal cavity. Formed by the maxillary, lacrimal, and inferior nasal concha bones. Transmits the anterior and posterior ethmoidal nerves and vessels, to the nasal cavity and the sphenoid and ethmoid sinuses. Anterior and posterior ethmoidal foramina.Formed by the ethmoid, frontal, lacrimal, and sphenoid bones. Transmits the infraorbital nerve (CN V-2) and vessels to the maxillary region of the face. Formed by the maxillary, zygomatic, and palatine bones. Formed by the zygomatic bone and the greater wing of the sphenoid bone. Transmits the supraorbital nerve and vessels to the scalp. Formed by the frontal bone and the lesser wing of the sphenoid bone. ![]()
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