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학습 자료 둘러보기 →Unilateral pupil dilation with a sluggish or fixed light response is a late and localizing sign of uncal herniation from CN III compression. This is a neurosurgical emergency requiring immediate notification.
This finding is a higher priority than a GCS drop or widening pulse pressure (Cushing's triad) because it indicates direct, irreversible brainstem compression is imminent. A change in pupil reactivity often precedes changes in vital signs.
Do not confuse this with direct ocular trauma. In a head-injured patient, assume a blown pupil is due to herniation until proven otherwise. Mannitol or hypertonic saline may be ordered as a temporizing measure while preparing for urgent CT and surgery.
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