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Integrating Brain Imaging Volumetrics and Quantitative Pupillometry for Predicting Neurologic Deterioration after
Yili Du1,2, Leigh Ann Mallinger1, Allyson L Reinert1
1Department of Neurology, Boston Medical Center, 1 Boston Medical Center PI, Boston, MA, 02118, USA.
Neurocritical Care
|May 5, 2026
Summary
Quantitative pupillometry and cerebrospinal fluid (CSF) volumetrics are aligned biomarkers that improve prediction of neurologic deterioration in large ischemic stroke patients. Combining these methods enhances monitoring of cerebral edema.
Area of Science:
- Neurology
- Radiology
- Critical Care Medicine
Background:
- Cerebral edema is a critical complication of large ischemic stroke, impacting patient outcomes.
- Cerebrospinal fluid (CSF) volumetrics via imaging and quantitative pupillometry assess edema and neurologic decline, respectively.
- The combined predictive value of these biomarkers for neurologic deterioration remains under investigation.
Purpose of the Study:
- To investigate the relationship between CSF volumetrics and pupillometry in large ischemic stroke.
- To evaluate the combined utility of these biomarkers in predicting neurologic deterioration.
- To establish the temporal alignment and complementary roles of these monitoring tools.
Main Methods:
- Retrospective study of 71 large middle cerebral artery stroke patients (2019-2024) with CT imaging and pupillometry.
- Automated image analysis for CSF volume extraction; pupillometry variables (NPi, dilation velocity) aligned with imaging.
- Statistical analysis using correlation, mixed-effects models, and Cox proportional hazards models to assess prediction of neurologic deterioration.
Main Results:
- Pupillometry and CSF measures showed significant correlation within 48 hours post-stroke.
- Lower hemispheric CSF volume ratio correlated with lower Neurological Pupil index (NPi) and greater NPi difference.
- Combined CSF volume and pupillometry models demonstrated superior prediction of neurologic deterioration (AUC 83.2%) compared to pupillometry alone (AUC 79.9%).
Conclusions:
- Pupillometry and imaging-derived CSF volumetrics are temporally aligned and serve as valuable biomarkers.
- These biomarkers collectively enhance the prediction of neurologic deterioration in stroke patients.
- Their complementary roles support integrated monitoring strategies for cerebral edema management.
