Fixed and dilated pupils by pupillometer in lateralized periodic discharges: a case report in the neurocritical care unit

Abstract

Background: Fixed and dilated pupils (FDPs) have become synonymous with devastating neurological damage and brainstem injury commonly associated with mass effect and herniation. Infrequently, changes in pupillary light response have been described with seizures; however, the loss of pupillary response with documented Neurological Pupil index has not been well established in patients with seizures.Case Report: We present a case report describing a middle-aged female patient with focal status epilepticus with intermittent FDPs. An abnormal pupillary response occurred with right hemispheric lateralized periodic discharges and resolution with anti-seizure medication escalation. To our knowledge, this is the first description of objective documentation of reversible FDP as a possible clinical correlate of lateralized periodic discharges. Conclusion: The use of handheld automated pupillometry in conjunction with electroencephalogram (EEG) has provided the therapeutic direction. Further research is warranted to fully describe the mechanistic underpinnings of these observations.