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Published on: March 26, 2019
Long term outcome in patients with severe head injury and bilateral fixed dilated pupils
J Sousa1, R R Sharma, S J Pawar
1Department of Neurosurgery, Khoula Hospital, Muscat 116, Sultanate of Oman.
Insights
Severe head injury patients with dilated pupils have a poor prognosis. This study analyzed 166 patients, finding 25.3% had functional outcomes, while 74.7% had poor outcomes, highlighting critical prognostic factors.
Area of Science:
- Neurosurgery
- Trauma Care
- Neurology
Background:
- Severe head injury with bilateral dilated unreactive pupils indicates a grave prognosis.
- Aggressive management and careful planning are crucial for improving outcomes in these critical patients.
Purpose of the Study:
- To analyze the long-term outcomes of patients with severe head injury and bilateral dilated unreactive pupils.
- To identify significant prognostic factors influencing survival and functional recovery in this patient cohort.
Main Methods:
- Retrospective analysis of 166 consecutive patients with severe head injury (initial Glasgow Coma Scale [GCS] ≤ 8) and post-resuscitation bilateral dilated unreactive pupils.
- Data collected from January 1996 to December 2000.
- Evaluation of computed tomography (CT) scan findings, including basal cistern obliteration and contusion.
Main Results:
- Functional outcome (good recovery or moderate disability) was achieved in 42 (25.30%) patients.
- Poor outcome (death or severe disability) occurred in 124 (74.69%) patients.
- Adverse prognostic factors included advanced age, polytrauma with shock, lower initial GCS (3 or 4), and basal cistern compression on CT scans.
Conclusions:
- A significant proportion of severe head injury patients with bilateral dilated unreactive pupils experience poor outcomes.
- While motor function may improve, neuro-behavioral and cognitive deficits persist in survivors with functional outcomes.
- Early identification of prognostic factors is essential for guiding treatment strategies and patient management.
Abstract:
Patients with severe head injury with bilateral dilated unreactive pupils are considered to have a grave prognosis. Hence proper planning and aggressive management becomes mandatory for achieving good results. We present the outcome of consecutive 166 patients with severe head injury, admitted between January 1996 and December 2000 and analysed retrospectively. All the patients had an initial GCS of 8 or less and post resuscitation bilateral dilated unreactive pupils. Our aim was to analyze the long term outcome in these patients and identify the other significant prognostic factors. Of the 166 patients, 42 (25.30%) had a functional outcome (good recovery in 10.24%, moderate disability in 15.06%), and 124 (74.69%) had a poor outcome (death in 58.43% and severe disability in 16.26% of cases). There were 45 patients with polytrauma and 24 of these patients (53.33%) succumbed to the injuries. Obliteration of the basal cisterns and contusion were the common CT scan findings. Factors adversely affecting the survival included age of the patient, polytrauma with shock, initial GCS of 3 or 4, and compression of the basal cisterns on the initial CT scans. At follow up, most of the patients with a functional outcome showed a significant improvement in their motor function but continued to have neuro-behavioral and cognitive deficits.
