How Reliable Is Pupillary Evaluation Following Subarachnoid Hemorrhage? Effect of Oculomotor Nerve Degeneration Secondary to Posterior Communicating Artery Vasospasm: First Experimental Study

Cengiz Ozturk; Nuriye Guzin Ozdemir; Ayhan Kanat; Mehmet Dumlu Aydin; Huseyin Findik; Nazan Aydin; Mehmet Esref Kabalar; Hizir Kazdal; Coskun Yolas; Orhan Baykal; Muhammet Calik

doi:10.1055/s-0037-1608841

Journal of Neurological Surgery Part A: Central European Neurosurgery, Table of Contents

J Neurol Surg A Cent Eur Neurosurg 2018; 79(04): 302-308
DOI: 10.1055/s-0037-1608841

Original Article

Georg Thieme Verlag KG Stuttgart · New York

How Reliable Is Pupillary Evaluation Following Subarachnoid Hemorrhage? Effect of Oculomotor Nerve Degeneration Secondary to Posterior Communicating Artery Vasospasm: First Experimental Study

Authors

Cengiz Ozturk

¹Family Medicine, Osmangazi Health Center, Erzurum, Turkey
Nuriye Guzin Ozdemir

²Department of Neurosurgery, Istanbul Training and Research Hospital, Istanbul, Turkey
Ayhan Kanat

³Department of Neurosurgery, Medical Faculty, Recep Tayyip Erdogan University, Rize, Turkey
Mehmet Dumlu Aydin

⁴Department of Neurosurgery Medical Faculty, Ataturk University, Erzurum, Turkey
Huseyin Findik

⁵Department of Ophthalmology, Recep Tayyip Erdogan University, Rize, Turkey
Nazan Aydin

⁶Psychiatry Clinic, Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
Mehmet Esref Kabalar

⁷Department of Pathology Clinic, Regional Training and Research Hospital, Erzurum, Turkey
Hizir Kazdal

⁸Department of Anesthesiology and Reanimation, Recep Tayyip Erdogan University, Rize, Turkey
Coskun Yolas

⁹Department of Neurosurgery, Regional Training and Research Hospital, Erzurum, Turkey
Orhan Baykal

¹⁰Department of Ophthalmology, Medical Faculty, Ataturk University, Erzurum, Turkey
Muhammet Calik

¹¹Department of Pathology, Medical Faculty, Ataturk University, Erzurum, Turkey

Abstract

Background and Study Aim Basic neurophysiologic principles of the light reflex are well known. However, the effects of degenerated axon densities of oculomotor nerves (OMNs) secondary to posterior communicating artery (PComA) vasospasm following subarachnoid hemorrhage (SAH) have not been investigated. Our aim was to study this subject.

Methods This study was conducted on 19 rabbits. There was a control group of five animals, a sham group of five animals in which saline was injected into the cisterna magna and a study group of nine animals in which homologous blood was injected into the cisterna magna. Pupillary diameters were measured for 1 week, then the animals were decapitated. The normal and degenerated axon densities of the OMNs were examined by stereological methods. Vasospasm indexes (VSIs) of posterior communicating arteries (PComAs) supplying OMNs were estimated and analyzed statistically.

Results The pupillary diameter was 5.439 ± 368 µm, and the mean axon density of the OMNs was 0.924 ± 324/mm³ in the control group. The pupillary diameter and degenerated axon density of the OMNs in animals of the sham group were 6.980 ± 0.370 µm and 36 ± 8/mm³, respectively. The pupillary diameter was 9.942 ± 653 µm, and degenerated axon density of the OMNs was 265 ± 57/mm³ in animals with SAH. The mean VSI values of PComAs were 0.927 ± 0.224 in the control group, 1.542 ± 0.257 in the sham group, and 2.321 ± 0.324 in the SAH group.

Conclusion We found a linear relationship between the axon density of the OMNs and pupillary diameters. High degenerated neuron density in the OMNs may be responsible for an unresponsive pupillary that has not been mentioned in the literature.

Keywords

oculomotor nerve - pupillary diameter - subarachnoid hemorrhage

Full Text

References

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