Pupillary response

Upon admission and control of seizure activity, a neurologic exam should be conducted to evaluate level of consciousness (coma, lethargy, and somnolence), motor function and reflexes (rhythmic contractions, rigidity, spasms, and posturing), and pupillary response. A physical exam to identify secondary injuries from the SE should also be conducted. 

Retinal-degenerate mice lacking cryptochromes show markedly decreased behavioural photoresponses and pupillary responses, while non-degenerate mice lacking cryptochromes show intact photic signalling... 

Van Gelder Again, how these different pigments play into the different output pathways is not clear. For example, in the pupillary light responsiveness we see a marked diminution in pupillary response comparing wild-type to rd rd mice. We see no diminution in phase-shifting response for entrainment in these animals. This means that, for pupillary responses, 90% of the response is driven by the outer retina, whereas for circadian responses it may be that none or only a small fraction is normally mediated by the outer retina. 

Foster It was because of this variability that we first started using the pupillary response. Having done phase shifts for most of my life it is quite extraordinary to see an error bar. The error bar falls within the data points. This is why we were so pleased with the action spectrum, because it shows so little variation we can be confident of the fit. 

Van Gelder I disagree. The measured pupillary response depends on the exact second that you measure the pupil size, because there is second-to-second variation in the pupil size that does produce somewhat of an error bar. 

Foster want to go back to the triple knockout. You showed that the rdjrd mCrj1 V mCrj2 l doesn t show a pupillary response. 

Van Gelder Phase shifting is a difficult assay because of the inherent variabihty and measurement difficulties. The pupillary response should provide a more robust platform for doing this. Our plan is to reintroduce different cryptochromes into the eye by this viral rescue technique and then see by site-directed mutagenesis whether we can actually show a shift in the action spectrum. 

Van Gelder And the math5 V mutants, which lack retinal ganglion cells, also lack a pupillary response. 

Miosis, or the pinpoint pupillary response to the opioids, is diagnostic of the use and abuse of the opioids. No tolerance to such an effect is observed. Miosis is due to disinhibition of the Edinger-Westphal nucleus in the cortex resulting in increased pupillary constrictor tone. 

Opioids are contraindicated in head trauma because of the risk of a rise in intracranial pressure from vasodilation and increased cerebrospinal fluid volume. In addition, in such patients the onset of miosis following opioid administration can mask the pupillary responses used diagnostically for determination of concussion. 

Physical effects also accompanied the experience. There was an intoxication that produced dizziness and a lack of coordination on trying to move about. The recording of the second session revealed slurred speech and awkward sentence patterns. Diaz had a decrease in heart rate accompanied by a chill. Both subjects had a normal pupillary response to a light shined into their eyes. 

In an effort to understand and quantify the effects of several classes of abused drugs on human pupillary response, a study, briefly described below, was conducted on the residential unit of the Intramural Research Program of the National Institute on Drug Abuse (NIDA). Further methodological details and results are published elsewhere.13... 

The aims of management are to identify the cause of the SAH, to treat the source of the bleeding to prevent recurrence, to prevent the general complications of stroke and to manage the complications of SAH (Vermeulen et al. 1992 Wijdicks 1995). Close monitoring using the Glasgow Coma Score and pupillary responses as well as for the development of focal deficits is required. 

Neurologic Assess level of consciousness, sensory and motor function, and pupillary response. Consult neurosurgery and obtain a head CT if a head injury is suspected. Maintain spine precautions. Consult neurosurgery or orthopedics if an injury is suspected. Secondary brain injury may result from increased intracranial pressure and hypoxia may lead to secondary brain injury. 

Atropine is contraindicated for patients who are hypersensitive to the belladonna alkaloids, have open-angle or angle-closure glaucoma, or have a tendency toward lOP elevations. Manufecturers recommended dosages should not be exceeded, particularly in infants, small children, and the elderly. Children with Down s syndrome demonstrate a hyperreactive pupillary response to topical atropine. 

Pharmacokinetic data indicate that ketorolac penetrates the cornea after topical ocular administration and reaches concentrations that reduce prostaglandin E levels in the aqueous humor. Plasma levels of ketorolac after topical ocular application are usually below detectable limits compared with oral administration. Ketorolac does not affect lOP, pupillary response, or visual acuity. 

Patients who have had cataract extraction with implantation of an intraocular lens (lOL) often have pupils that dilate less well than they did preoperatively.The poorer pupillary response probably relates to the amount of iris trauma occurring at surgery. The difference in mydriatic response may affect evaluating and treating peripheral retinal abnormalities in aphakic and pseudophakic eyes. However, even with maximally dilated pupils often the capsulotomy is the limiting fector. 

Transient central blindness has followed an intravenous injection of atropine 0.8 mg in the course of spinal anesthesia blink reflex and pupillary response to light and accommodation were lost vision returned slowly after some hours after the instillation of pilocarpine (6). 

Dark adaption test Pupillary response test Plasma retinol concentration Relative dose response... 

In addition to an assessment of language and cognitive abilities, the physical examination also should assess motor, sensory, and reflex abnormalities and pupillary response, asymmetry, and posturing on neurologic examination. Because generalized seizures may cause physical injury, the patient should be examined for secondary injuries (e.g., tongue lacerations, shoulder dislocations, head trauma, and facial trauma). 

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