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학습 자료 둘러보기 →A bilaterally fixed and dilated pupil is the most critical sign of uncal herniation from a mass effect like a subdural hematoma. This indicates severe compression of the oculomotor nerve (CN III) and brainstem, representing a pre-arrest state.
This finding demands immediate surgical decompression (e.g., craniotomy, burr hole). It is the clinical tipping point where irreversible brain damage is imminent but may still be averted. The sequence often progresses from a unilateral fixed pupil to bilateral involvement.
Do not confuse this with a GCS drop or Cushing's triad (hypertension, bradycardia, irregular respirations). While serious, these are earlier or compensatory signs. The bilateral fixed pupil is the immediate precursor to respiratory and cardiac arrest.
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