Implication of Neurological Pupil Index for Monitoring of Brain Edema

Malignant middle cerebral artery (MCA) infarction is associated with poor neurologic outcome due to its high risk for brain swelling and transtentorial herniation [1,2]. Standard treatment for intracranial pressure (ICP) crisis in malignant MCA infarction includes osmotic therapy and decompressive hemicraniectomy. When surgical decompression is not indicated, targeted temperature management (TTM) can be used as an alternative option [2]. TTM is an effective therapeutic option for reducing brain edema, which was proven to improve functional outcome in patients with malignant MCA infarction [3,4]. However, TTM often requires light sedation to minimize shivering, which possibly limits early detection of neurologic worsening. For continuous neurological assessment, serial pupillary examination has been performed in the neurological intensive care unit (NICU).