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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >THE UTILITY OF PUPILLARY LIGHT REFLEX AS AN OBJECTIVE BIOMARKER OF ACUTE CONCUSSION IN THE ADOLESCENT ATHLETE
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THE UTILITY OF PUPILLARY LIGHT REFLEX AS AN OBJECTIVE BIOMARKER OF ACUTE CONCUSSION IN THE ADOLESCENT ATHLETE

机译：效用小学生光反射作为青少年体育中急性休克的目标生物标志物

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Background: Visual deficits and autonomic dysfunction have been well recognized following pediatric concussion. Testing of the pupillary light reflex (PLR) is a simple, non-invasive, and objective approach to examine the autonomic nervous system by accessing the brain pathways. The aim of this study was to objectively evaluate adolescent pupillary responses to a light stimulus after a physician-diagnosed concussion and compare them to baseline responses. Methods: In this prospective cohort study, PLR was assessed in 135 adolescent athletes (ages 14-18) during their sport pre-season. All of the athletes were not recovering from a concussion at the time of their baseline assessment. Within this cohort, seven athletes (ages 14-17) sustained a concussion during their sport season and had longitudinal post-injury assessments of PLR through their recovery. The PLR was obtained in response to a brief step-input (0.8 seconds) white light stimulus using a hand-held pupillometer (stimulus recording duration= 5 seconds, light intensity= 150 lux). Pre-set and automated device-generated parameters used for analysis include the minimum and maximum pupil diameter, response amplitude and latency, mean constriction and dilation velocities and the maximum constriction velocity of the eye in response to a light stimulus. During each assessment, three monocular trials were performed in each eye alternatively, and the responses for each eye were subsequently averaged. Results: Six out of the seven concussed adolescents showed response enhancement of about 20% (IQR 11-33%). Enhancement was noted in the steady state diameter with a mean of 24% (median 18%), minimum pupil diameter mean of 17% (median 11%) and maximum constriction velocity mean of 28% (median 33%) following concussion, which decreased during the recovery process (days to weeks post-injury) to pre-injury or below initial pre-injury baseline measurements. Pupillary responsivity was found to be significantly enhanced after concussion compared to baseline measurements, waning over time. Maximum constriction velocity better highlighted the enhancement compared to the baseline pupil diameter. Conclusions/Significance: Pupil responsivity was found to be significantly enhanced after concussion compared to baseline measurements which waned over time during recovery. Assessment of dynamic PLR responses has potential utility as an objective biomarker to aid in concussion diagnosis on the sidelines or in the office, allowing physicians to quantify function (and dysfunction) of the autonomic nervous system under parasympathetic and sympathetic control after concussion.
机译：背景：小儿脑震荡后，视觉缺陷和自主神经功能障碍已得到公认。瞳孔光反射（PLR）的测试是一种简单的，非侵入性且客观的方法，可通过访问大脑通路来检查植物神经系统。这项研究的目的是客观评估医生诊断为脑震荡后青少年瞳孔对轻刺激的反应，并将其与基线反应进行比较。方法：在这项前瞻性队列研究中，对135名青少年运动员（14-18岁）在运动前期进行了PLR评估。在进行基线评估时，所有运动员均未从脑震荡中恢复。在该队列中，有7名运动员（14-17岁）在运动季节遭受了脑震荡，并通过康复对其PLR进行了纵向伤后评估。使用手持式瞳孔计（刺激记录持续时间= 5秒，光强度= 150 lux）响应短暂的步进输入（0.8秒）白光刺激而获得PLR。用于分析的预设和自动设备生成的参数包括最小和最大瞳孔直径，响应幅度和潜伏时间，平均收缩和扩张速度以及响应光刺激的眼睛的最大收缩速度。在每次评估期间，每只眼睛交替进行三个单眼试验，然后平均每只眼睛的反应。结果：七个脑震荡青少年中有六个显示出约20％的反应增强（IQR 11-33％）。脑震荡后，稳态直径平均增加24％（中位18％），最小瞳孔直径平均17％（中位11％），最大收缩速度平均28％（中位33％），下降在恢复过程中（受伤后的几天或几周）到受伤前或低于最初的受伤前基线测量值。与基线测量值相比，脑震荡后瞳孔反应性显着提高，并且随着时间的流逝逐渐减弱。与基线瞳孔直径相比，最大收缩速度更好地突出了增强作用。结论/意义：与基线测量相比，脑震荡后学生的反应能力显着增强，而基线测量在恢复过程中随着时间的流逝逐渐减弱。动态PLR反应的评估具有潜在的实用性，可作为客观的生物标志物来辅助在院外或办公室进行脑震荡诊断，从而使医生能够量化脑震荡后副交感神经和交感神经控制的自主神经系统的功能（和功能障碍）。

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