A unilated cataract had been reported to cause a relative afferent pupillary defect (RAPD) in the contralateral eye. After extraction of the cataract, the RAPD disappeared in every case. The ability of cataracts to induce an RAPD in the opposite eye is presumed to increased intraocular scatter of light by the cataract, stimulating more peripheral photoreceptors. This observation has not been reported in Korea. The authors have also observed RAPD in the contralateral eye to the unilateral cataract in six patients, disappearing after cataract surgery. Thus, when an RAPD is seen in an eye with a cataract, a visual pathway defect in that eye should definitely be suspected. In addition, it would be better to hold the brain imaging study when an RAPD is noticed in the contralateral eye to the unilateral cataract and to confirm the normal pupillary reflex in both eyes after the cataract surgery.
Cataract* ; Humans ; Korea ; Neuroimaging ; Pupil Disorders* ; Reflex, Pupillary ; Visual Pathways

PURPOSE: To determine the normal ranges of various indexes of the pupillary light reflex measured by automated pupillometry in Koreans. METHODS: We retrospectively analyzed 90 healthy adults who did not have any ocular diseases other than refractive errors. The direct pupillary light reflex was measured with an automated dynamic pupillometer (PLR-200, NeurOptics Inc., Irvine, CA, USA). A total of 7 indices were measured as follows; the maximum and minimum pupil diameters, constriction latency, constriction ratio, maximum constriction velocity, average constriction velocity and average dilation velocity. RESULTS: There were no significant differences in quantitative indexes of the pupillary light reflex between fellow eyes. A significant decrease in maximum pupil diameter, minimum pupil diameter, maximum constriction velocity, average constriction velocity and average dilation velocity were observed with aging. In contrast, a significant increase in constriction latency was observed with aging. There were no differences in quantitative pupil measurements according to gender (p<0.001). CONCLUSIONS: Quantitative measurements of the pupillary light reflex by dynamic pupillometry showed no significant differences between fellow eyes. A significant decrease in pupil size, constriction velocity and dilation velocity, and an increase in pupil constriction latency were observed with aging.
Adult ; Aging ; Constriction ; Humans ; Pupil ; Reference Values ; Reflex* ; Reflex, Pupillary ; Refractive Errors ; Retrospective Studies

Clinical assessment of gestational age in 251 newborns of the term and post-term born at the Seoul National University Hospital from March 1977 to Sept. 1977 was carried out to study the correlaticn between the gestational age derived from LMP and the clinically estimated gestational age utilizing Lubchenco's method. The results are as follows; 1) number of items, among clinical physical criteria, that demonstrated the high correlation percentage from 75 to 100% between the gestational age by LMP and the clinically estimated gestational age with clinical physical criteria was observed in 13items in 38 week, 11 items in 39 weeks, 8 items in 40 weeks, 5 items in 41 weeks and 4 items in 42 weeks or more respectively, with remarkable decline of the correlation percentage as the gestational age is advanced. The steady high correlation percentage thoroughout from the term to post-term gestational age was noted in item of recoil-leg, hair, lanugo and recoil-arm. 2) The high steady correlation percentage between the gestational age by LMP and one by neurologic examination is observed in items of rooting reflex, vertical position, pupillary reflex, glabellar tap, in order among neurologic examination, although their correlation is declining along with the advancement of gestationa age. 3) Neurologic examination seems to be better than clinical physical criteria, in estimating the gestational age.
Gestational Age* ; Hair ; Humans ; Infant, Newborn* ; Neurologic Examination ; Reflex ; Reflex, Pupillary ; Seoul

One hundreds eighty cases of traumatic intracerebral hematoma(TICH) among 1,633 head injury patients diagnosed with computerized tomography in neurosurgical department from Jan. 1990 to Jun. 1996. were classified into two TICH groups; TICH group associated with other traumatic intracranial lesions and TICH group without other traumatic intracranial lesions. The incidence of TICH was 11.0% and percentage of TICH with other traumatic intracranial lesions among 180 cases of TICH was 66.7%. TICH group with other traumatic intracranial lesions showed worse initial level of consciousness, more likely to have abnormal pupillary reflex, higher incidence of delayed traumatic intracerebral hematomas(DTICH), greater amount of hematoma, increased chance of surgery and worse outcome. In TICH group with other traumatic intracranial lesions, the factors affecting prognosis were initial Glasgow coma scale(GCS) score, pupillary reflex, amount of hematoma and treatment modality. In TICH only group, the factors affecting prognosis were initial GCS score, pupillary reflex, amount of hematoma and DTICH. The patients with 12-15 of GCS score, normal pupillary reflex, absence of DTICH, and amount of hematoma below 10cc, the presence of other traumatic intracranial lesions were found to be important prognostic factor. The overall mortality was 27.7% but in TICH group with other traumatic intracranial lesions, the mortality was 35.0% compared to 13.3% in TICH only group. It is concluded from this study that in the case with other traumatic intracranial lesions, TICH showed worse initial neurological status and prognosis compared to those without other lesions. Thus, these patients, although in conditions of good general clinical index at admission, should be considered to provide intensive care and treatment because these associated lesions will play as a bad prognostic factor.
Coma ; Consciousness ; Craniocerebral Trauma ; Hematoma* ; Humans ; Incidence ; Critical Care ; Mortality ; Prognosis ; Reflex, Pupillary

PURPOSE: Pupillary examination is an important objective method to diagnose lesions of the anterior visual pathways. However, errors and faults may easily alter the interpretation and value of the test as it is highly dependent on the examiner's skills. Therefore, we tried to develop a pupillography which is independent of the examiner. METHODS: Hardware composed of a binocularly measuring instrument adapted for an infrared charge coupled device (CCD) was developed. Two arrays of infrared light emitting diodes (LED) were supplied in front of each of the subject's eyes. A microcontroller to modulate these LED was developed, as was software to save and analyze the pupil images. The hardware was able to deliver a light to either eye or to both eyes, and to change the time, frequency, and intensity of the stimulus. The software automatically analyzed the pupil size and location by image processing. Pupil size was calculated continuously. After artifact elimination, the response amplitudes of the pupils were determined for the right and left pupils. RESULTS: Pupillary images of size 320 x 240, at 30 frames/second, were saved and processed to evaluate the change of the actual pupil size and the velocity of pupillary response. CONCLUSIONS: A pupillography to measure, save and analyze the pupillary response using image processing was developed. Further detailed clinical studies with a large number of patients will be required to validate this new method.
Diagnostic Techniques, Ophthalmological/*instrumentation ; Equipment Design ; Humans ; *Image Processing, Computer-Assisted ; *Reflex, Pupillary

In this report, the authors analyzed retrospectively 20 cases of pure traumatic basal ganglia hemorrhage(TBGH), which were diagnosed and treated in our hospital between January 1990 and June 1995. The TBGH incidence constitutes 1.4% of all head trauma. It occures were commonly among the younger male patient groups. The main causes of trauma was motor vehicle accidents. The overall mortality rate was 15%. Low initial GCS score, fixed pupillary reflex, pathologic reflex, poor motor response and large hematoma size were all poor prognostic factors, resulting a high mortality or passimistic outcome.
Basal Ganglia Hemorrhage* ; Basal Ganglia* ; Craniocerebral Trauma ; Hematoma ; Humans ; Incidence ; Male ; Mortality ; Motor Vehicles ; Reflex ; Reflex, Pupillary ; Retrospective Studies

As the development of CT scan enabled rapid and precise diagnoses of epidural hematoma, recent efforts have been sought to reduce its mortality rate. This study is a retrospective clinical analysis of one hundred eighty-one consecutive cases of epidural hematoma treated at the Department of Neurosurgery in Dong-guk University Hospital between Jan. 1991 and Dec. 1994. The rate of unsatisfactory outcome is 10.5%, While the mortality rate is 4.9%. Delayed epidural hematoma was founded tobe 12%. The authors have attempted to identify the factors influencing the prognosis of epidural hematoma. Based on the results of the above study we concluded that age, initial Glasgow coma scale, pupillary reflex and its size, IICP findings on brain CT, hematoma amount, associated intracranial lesions, rate of development of symptoms and timing of operation after injury are all relevant prognostic factors.
Brain ; Diagnosis ; Glasgow Coma Scale ; Hematoma* ; Mortality ; Neurosurgery ; Prognosis ; Reflex, Pupillary ; Retrospective Studies ; Tomography, X-Ray Computed

The authors have analyzed retrospectively a series of 102 consecutive patient with severe head injury who were admitted to the department of Neurosurgery, Dong Guk Univ. Hosp. between January, 1989, and December, 1989. All patients, after appropriate cardiopulmonary resuscitation, diagnostic measure, and, when required, surgical treatment, were managed in ICU with usual care method. The outcome has been analyzed 4 month later. The overall mortality rate was 36%. Of the survivors, 65% made good recovery or moderate disability, 22% remained severely disabled, and 14% were in a persistent vegetative state. Mortality rates at the variable GCS scores were 82% at 3-4, 25% at 5-6, and 14% at 7-8. The most reliable predictive factors were : Glasgow coma scale, motor response, pupillary reflex at admission.
Cardiopulmonary Resuscitation ; Craniocerebral Trauma* ; Glasgow Coma Scale ; Head* ; Humans ; Mortality ; Neurosurgery ; Persistent Vegetative State ; Reflex, Pupillary ; Retrospective Studies ; Survivors

Intraventricular hemorrhage(IVH) from any source is generally considered to be of grave prognostic significance. However, little is known about the prognostic effect of fourth IVH. The analysis of 65 patients with computerized tomography(CT)-documented fourth IVH treated between 1990 and 1994 is here in presented. The etiologies of the studied fourth IVH include hypertensive intracranial hemorrhage(39 cases), spontaneous subarachnoid hemorrhage(12 cases), primary IVH(9 cases), trauma(4 cases), Moyamoya disease(1 case). A 66.7% mortality rate was found in patients with a Glasgow coma scale(GCS) score of 3 to 5, 53.8% for those with a GCS score of 6 to 8, 28.6% for those patients with a GCS score of 9 to 12, and 9.5% for patients with a GCS score of 13 to 15. Admission status was significant outcome predictor(p<0.001). The mortality rate for patients with dilatation and fixed pupil was 64.7%. Pupillary reflex was also used as an outcome predictor(p<0.05). The mortality rate of patients with hemorrhagic dilatati on of the fourth ventricle was 70% while those with no hemorrhagic dilatation of the fourth ventricle was 28.9%. Hemorrhagic dilatation of the fourth ventricle was a potent predictor of outcome in fourth IVH(p<0.005). The mortality rate of patients with a ventriculocranial ratio(VCR) of 0.23 or more than 0.23, as calculated from initial CT scan, was 76.5% and those with a VCR of less than 0.16 was 26.7%. We have found that VCR is a potent prodictor of outcome in fourth IVH(p<0.005). The prognostic values of age, etiology of fourth IVH, lood pressure, the number of ventricle of hemorrhage presenting was found to be statistically insignificant. Patients with all ventricular hemorrhage and urokinase irrigation have a 64.5% mortality rate. Patients with fourth IVH and hemorrhagic dilatation of fourth ventricle, increased VCR, poor admission status, dilatation and fixed pupil are considered poor prognosis. Urokinase irrigation was the recommended management for these patients.
Coma ; Dilatation ; Fourth Ventricle ; Hemorrhage* ; Humans ; Mortality ; Prognosis ; Pupil Disorders ; Reflex, Pupillary ; Tomography, X-Ray Computed ; Urokinase-Type Plasminogen Activator

A Dilated pupil with a loss of reactions to light and accommodation convergence exhibit these defects in varying degree, and occur under a variety of circumstances. These conditions include unilateral dilatation and fixity of the pupil as a result of injury to the eye and as the result of ipsilateral cerebral compression and bilaterally dilated and fixed pupils seen commonly in juvenile paresis and tabo-paresis. There are another unknown circumstances as tonic pupil. The authors presented a case of 22 years old Korean female under the diagnosis of dilated and fixed pupil which possibly originated from syphilis in as much as she was strongly positive reaction in serum S.T.S. and her abnormal pupil was recovered after anti-syphilitic therapy. The authors reviewed the literatures concerning these conditions and discussed about the possibility of early involvement of syphilis in the nervous system and the possible site of lesion which interefere pupillary reflex to light and accommodation-convergence. Finally authors commented the possible site of lesion is efferent pupilloconstrictor fibers which pass through the tentorial gap. In this region para-sympathetic pupilloconstrictor fibers, concentrated over the superior are of the oculomotor nerve, may be compressed upon its superior surface by inflammatory swelling of syphilitic involvement of adjacent structures.
Diagnosis ; Dilatation ; Female ; Humans ; Nervous System ; Neurosyphilis ; Oculomotor Nerve ; Pupil ; Pupil Disorders* ; Reflex, Pupillary ; Syphilis ; Tonic Pupil ; Young Adult