Early Head Computed Tomography Abnormalities Associated with Elevated Intracranial Pressure in Severe Traumatic Brain Injury

2020 ◽  
Author(s):  
Nick M. Murray ◽  
Dylan N. Wolman ◽  
Michael Mlynash ◽  
Zachary D. Threlkeld ◽  
Soren Christensen ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Severe Traumatic Brain Injury ◽  
Elevated Intracranial Pressure ◽  
Head Computed Tomography

Isoflurane-Associated Mydriasis Mimicking Blown Pupils in a Patient Treated in a Neurointensive Care Unit

2016 ◽  
Vol 78 (04) ◽  
pp. 403-406 ◽  
Author(s):  
Eva Korf ◽  
Volker Tronnier ◽  
Jan Gliemroth ◽  
Jan Küchler
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Cranial Computed Tomography ◽  
Elevated Intracranial Pressure ◽  
Neurointensive Care Unit ◽  
Intravenous Treatment ◽  
Cerebral Herniation ◽  
Diagnostic Investigations

AbstractWe report a misinterpretation of bilateral mydriasis as blown pupils related to elevated intracranial pressure (ICP) under volatile sedation with isoflurane (Anesthetic Conserving Device [AnaConDa], Hudson RCI, Uppland Vasby, Sweden) in a 59-year-old patient with a severe traumatic brain injury with frontal contusion. The patient showed bilateral mydriasis and a missing light reflex 8 hours after changing sedation from intravenous treatment with midazolam and esketamine to volatile administration of isoflurane. Because cranial computed tomography ruled out signs of cerebral herniation, we assumed the bilateral mydriasis was caused by isoflurane and reduced the isoflurane supply. Upon this reduction the mydriasis regressed, suggesting the observed mydriasis was related to an overdose of isoflurane. Intensivists should be aware of the reported phenomenon to avoid unnecessary diagnostic investigations that might harm the patient. We recommend careful control of the isoflurane dose when fixed and dilated pupils appear in patients without other signs of elevated ICP.

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