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학습 자료 둘러보기 →A unilaterally fixed and dilated pupil in a child with head trauma is a late sign of uncal herniation from elevated ICP. Compression of CN III interrupts parasympathetic fibers, impairing constriction.
This finding requires immediate intervention to reduce ICP, such as elevating the head of bed to 30 degrees, ensuring midline head alignment, and notifying the neurosurgical team for possible hyperosmolar therapy or emergency decompression.
Do not confuse this with benign anisocoria; a pupil that is both unequal and non-reactive to light in the setting of acute TBI is a neurosurgical emergency. Reassess vital signs for Cushing's triad (hypertension, bradycardia, irregular respirations), but do not delay intervention waiting for its appearance.
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