![]() ![]() Following admission to the ICU, two made a full recovery to employment and 3 survived with moderate disability to live at home.Īfter having these 5 cases, they changed their hospital protocol to plan to admit all cases for 72 hours of supportive care and observation. Manara et al published a case series from a trauma centre in the UK of five patients over the last 2 years with perceived devastating brain injury in whom withdrawal of care was delayed to facilitate organ donation. Given trauma often coincides with toxicology if we can satisfy ourselves that their pupils have an intracranial cause, we know historically they can have good outcomes, but what if we treat them more aggressively? CNS disease, Trauma, raised intracranial pressure.Thomas(2000), suggests a simple structure for differentiate the possible causes. To be able to prognosticate, we need to breakdown the causes of fixed dilated pupils. So we can see that especially for extradurals fixed dilated pupils are certainly not a death sentence. The most recent meta-analysis of this was published by Scotter et al in 2015 found 5 high quality studies between 1993-2003 on patients with bilateral fixed dilated pupils secondary to subdural or extradural haematomas having surgical evacuation.įor extradural haematomas they found a pooled mortality of only 29% with 54.3 % having good functional outcomes. Subdural haematomas had worse outcomes with 66% mortality with only 6% having a good outcome. We seem to learn quite early in our medical careers that fixed dilated pupils are a very poor prognostic sign for our patients with intracranial pathology indicating brainstem herniation. However, what if the pupils are fixed and dilated? We have looked at the pupillary response before on this blog in terms of the Doll’s Eye Reflex in brainstem death and the oculocephalic reflex. Head injury with fixed dilated pupils: Are we done? ![]()
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