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학습 자료 둘러보기 →A new finding of unequal pupils with a sluggish response to light in an acute stroke patient is a late sign of uncal herniation and brainstem compression. This requires the most immediate intervention, often preceding a call to the provider while preparing for hyperosmolar therapy or emergency surgery.
Cushing's triad (hypertension, bradycardia, irregular respirations) is also a late sign of elevated ICP but represents a compensatory mechanism. A fixed, dilated pupil indicates actual mechanical compression of CN III and is a more specific and equally critical sign of impending irreversible injury.
Do not wait for Cushing's triad to fully develop. A single, newly blown pupil in the setting of acute stroke is a neurosurgical emergency. Immediately notify the provider and prepare for interventions to rapidly lower ICP, such as administering mannitol or hypertonic saline.
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