Integrating Brain Imaging Volumetrics and Quantitative Pupillometry for Predicting Neurologic Deterioration after...

Area of Science:

• Neurology
• Medical Imaging
• Critical Care Medicine

Background:

• Cerebral edema is a critical complication of large ischemic stroke.
• Cerebrospinal fluid (CSF) volumetrics via imaging and quantitative pupillometry assess edema and neurologic decline.
• The combined predictive value of these methods for deterioration is not well understood.

Purpose of the Study:

• To investigate the relationship between CSF volumetrics and pupillometry in ischemic stroke patients.
• To assess the combined utility of these biomarkers in predicting neurologic deterioration.

Main Methods:

• Retrospective study of large middle cerebral artery stroke patients with head CT and pupillometry data.
• Automated image analysis for CSF volumetrics; pupillometry variables aligned with imaging.
• Statistical analysis including correlations, mixed-effects models, and Cox proportional hazards models.

Main Results:

• Significant correlation found between pupillometry and CSF measures within 48 hours post-stroke.
• Lower hemispheric CSF volume ratio linked to lower Neurological Pupil index (NPi) and greater NPi difference.
• Combined models of CSF volume and pupillometry showed improved prediction of neurologic deterioration (AUC 83.5%) compared to pupillometry alone (AUC 81.0%).

Conclusions:

• Pupillometry and CSF volumetrics are temporally aligned biomarkers.
• These methods enhance the prediction of neurologic deterioration in ischemic stroke.
• Their complementary roles in monitoring cerebral edema are supported.