Bilaterally absent pupillary responses: not always a bad sign

Area of Science:

• Neurology
• Pediatric Critical Care
• Clinical Neuroscience

Background:

• Pupillary response assessment is a standard prognostic tool for severe brain injury.
• Absent pupillary responses are often equated with a grave prognosis.

Observation:

• This study examined outcomes in children with severe brain injury and bilaterally absent pupillary responses.
• A cohort of 89 brain-injured patients included 32 with bilaterally absent pupillary responses.

Findings:

• Six children (18.8%) with bilaterally absent pupillary responses, including four with traumatic brain injury and two with infective brain injury, achieved favorable outcomes.
• This challenges the assumption that absent pupillary responses invariably indicate a hopeless prognosis.

Implications:

• Clinicians should exercise caution when interpreting bilaterally absent pupillary responses as a sole predictor of outcome in pediatric brain injury.
• These findings may prompt a re-evaluation of prognostic guidelines in pediatric neurocritical care.
• Further research is warranted to explore factors contributing to favorable outcomes despite absent pupillary responses.