The changing paradigm from subjectivity to objectivity in pupillary assessment during neurological examination

Published:January 21, 2019DOI:
      Pupillary assessment beside Glasgow coma scale (GCS) is an important part of neurological assessment because changes in the size, equality and reactivity of the pupils can provide vital diagnostic information in the critically ill and injured patient [
      • Fledelius H.C.
      Ultrasound in ophthalmology.
      ]. Pupil index (NPi) is being used as a sensitive measure of pupil reactivity and an early indicator of increasing intracranial pressure (ICP). Raised ICP may occur in patients with severe traumatic brain injury (TBI), aneurysmal subarachnoid hemorrhage, or intracerebral hemorrhage (ICH) and other acute neurological emergencies [
      • Olson DaiWai M.
      • Fishel Megan
      The use of automated pupillometry in critical care.


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