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British Journal of Anaesthesia, 2001, Vol. 86, No. 5 717-720
© 2001 The Board of Management and Trustees of the British Journal of Anaesthesia

Abnormal pupillary activity in a brainstem-dead patient

D. Shlugman*,1, M. Parulekar2, J. S. Elston2 and A. Farmery3

1Neuro Intensive Care Unit, 2 Department of Ophthalmology and 3Nuffield Department of Anaesthetics, Radcliffe Infirmary, Oxford OX2 6HE, UK*Corresponding author

The pupils in brainstem-dead patients are classically fixed and dilated. We present a case of a brainstem-dead patient whose pupils displayed persistent asynchronous pupillary constriction and dilatation independent of external physical stimuli. Central causes for the phenomenon were excluded leaving an unexplained peripheral cause as the most likely explanation. Early recognition of this phenomenon prevents delay in the diagnosis of brainstem death, lessening to some extent the distress for the family, and facilitating earlier organ donation and allowing the better use of resources.

Br J Anaesth 2001; 86: 717–20


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