J Neuroimaging. 2026 Sep-Oct;36(5):e70149. doi: 10.1111/jon.70149.
ABSTRACT
BACKGROUND AND PURPOSE: Diagnosing internal carotid artery dissection (ICAD) can be challenging even for experienced clinicians, as one of its most specific signs-Horner syndrome (HS)-is often missed during routine neurological examination (NE). This study aimed to evaluate pupillary reactivity in ICAD patients using ultrasound pupillometry (UP) and compare quantitative UP findings with standard NE.
METHODS: We enrolled 33 consecutive patients with acute ICAD and an age- and sex-matched healthy control group without ocular pathology. HS was assessed at admission using standard NE. UP was performed in both the affected eye (AE) and non-affected eye (NAE), measuring pupillary diameter (PD) and response time (PT) to light stimulus (LS) and ciliospinal reflex (CR). Ultrasound examinations were performed by a single operator, while all offline quantitative measurements were performed by a second investigator blinded to the neurological findings.
RESULTS: UP revealed significantly smaller PDs in the AE compared with the NAE, both at rest and after direct and consensual LS (3.23 ± 0.64 mm vs. 5.12 ± 0.51 mm, p < 0.01). The AE also showed reduced CR response in terms of mydriasis (4.03 ± 2.8% vs. 9.76 ± 3.36%, p < 0.01) and dilation time (2.984 ± 0.278 s vs. 2.071 ± 0.223 s, p < 0.01). Similar differences were observed between the AE and controls. Quantitative pupillary abnormalities were identified by UP in 96.9% of patients, whereas clinical HS was detected by standard NE in 39.4% (p < 0.01).
CONCLUSIONS: UP represents a promising Neuro-POCUS application for the objective, quantitative assessment of pupillary dysfunction in acute ICAD and may serve as a valuable adjunct to routine NE.
PMID:42806924 | DOI:10.1111/jon.70149