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학습 자료 둘러보기 →The most critical early neurological sign of rising intracranial pressure (ICP) and impending uncal herniation is a change in pupillary size and reactivity. An unequal pupil (anisocoria) that becomes sluggish or fixed to light indicates direct compression of cranial nerve III (oculomotor nerve).
This occurs when the medial temporal lobe herniates, compressing the parasympathetic fibers on the nerve's surface. The ipsilateral pupil will progressively dilate and lose reactivity. This is a late and ominous sign requiring immediate intervention.
Do not confuse this with Cushing's triad (hypertension, bradycardia, irregular respirations), which is a different late sign of ICP. Pupillary changes often precede or occur alongside vital sign changes and demand an urgent report to the provider.
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