Clinical utility of quantitative pupillometric monitoring in patients with acute brain injury.

Assessment of the pupillary reflex to light is essential in patients with acute brain injury, as pupillary abnormalities are associated with neurological impairment and elevated intracranial pressure. Manual assessment by headlamp is inaccurate, whereas quantitative pupillometry provides objective and accurate measurements of pupillary size and reactivity, anticipating severe neurological deterioration and allowing early intervention in life-threatening situations. The pupillary neurological index, a variable derived from automated pupillometry, correlates with intracranial pressure, allows monitoring of therapeutic response in trauma and status epilepticus, is associated with the severity of neurological damage and may serve as a predictor of unfavourable neurological prognosis. The aim of this review is to summarise the evidence on the clinical utility of monitoring by quantitative pupillometry in neurological emergencies.