{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T19:54:36Z","timestamp":1781639676040,"version":"3.54.5"},"reference-count":14,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"vor","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Medizinische Fakult\u00e4t Heidelberg der Universit\u00e4t Heidelberg"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Neurol Sci"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH) is common, but bedside markers of its physiological burden are limited. Quantitative pupillometry (QP) is objective and fast; whether it mirrors hydrocephalus severity is uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Single-center cohort of adults with aSAH undergoing ventriculoperitoneal shunting (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200917). Automated infrared pupillometry (NPi-200) was performed the day before surgery and on post-op day 1, recording Neurological Pupil index (NPi) and constriction\/dilation velocities (CV\/DV) as overall values (mean of both eyes) and inter-eye asymmetry (|OD\u2013OS|). Pre-op CT markers were combined into a standardized Hydrocephalus Severity Score (HSS; higher=worse).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Mean pre-op NPi was 3.81\u2009\u00b1\u20090.69 and post-op 4.03\u2009\u00b1\u20090.66; median \u0394NPi\u2009=\u2009+\u20090.13 (Wilcoxon\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.141). Responders (\u0394NPi\u2009\u2265\u2009+\u20090.5) were 5\/14 (35.7%). Cross-sectionally, overall values did not mirror ventricular size: NPi vs. HSS (\u03c1\u2009=\u20090.37,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.141, q\u2009=\u20090.423) and NPi vs. Evans index (EI) (\u03c1\u2009=\u20090.09,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.735, q\u2009=\u20090.735) were non-significant; CV\/DV vs. HSS were likewise neutral. In contrast, inter-eye CV asymmetry correlated with HSS (\u03c1\u2009=\u20090.68,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006, q\u2009=\u20090.017;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200916) and trended with Evans (\u03c1\u2009=\u20090.49,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.054, q\u2009=\u20090.161). In age\/sex-adjusted models, no radiologic metric, including HSS, reliably explained pathological NPi (&lt;\u20093).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In shunt-dependent aSAH hydrocephalus, pattern matters more than absolute value. Absolute NPi and mean velocities did not reflect ventricular size, whereas inter-eye constriction-velocity asymmetry captured composite radiologic burden, consistent with lateralized parasympathetic stress. Around shunt placement, QP behaved as a dynamic biomarker, revealing patient-level gains despite flat cohort averages. Findings support trend- and asymmetry-based pupillometry to complement imaging for CSF-pathway reassessment and early post-shunt surveillance, warranting prospective validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10072-026-08928-2","type":"journal-article","created":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T01:29:35Z","timestamp":1772501375000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Quantitative pupillometry as a sensitive tool for detecting hydrocephalus-related physiologic burden after aSAH: a prospective feasibility study"],"prefix":"10.1007","volume":"47","author":[{"given":"Jonas","family":"Lin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorothea","family":"Mitschang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viktoriya","family":"Sydorenko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Younsi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"El Damaty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Dugas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandro M.","family":"Krieg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3842-0783","authenticated-orcid":false,"given":"Pavlina","family":"Lenga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,3]]},"reference":[{"issue":"2","key":"8928_CR1","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1016\/j.nec.2009.10.013","volume":"21","author":"AV Germanwala","year":"2010","unstructured":"Germanwala AV, Huang J, Tamargo RJ (2010) Hydrocephalus after aneurysmal subarachnoid hemorrhage. 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The waiver was granted because quantitative pupillometry is part of routine institutional clinical care and only de-identified data were analyzed. All procedures complied with the Declaration of Helsinki and relevant institutional regulations.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"No individual person\u2019s data were included in this study (not applicable).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"We confirm that this manuscript conforms to the Neurocritical Care Instructions for Authors, including formatting, ethical requirements, and reporting standards.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with instructions for authors"}},{"value":"We confirm that this work is original, has not been published elsewhere in whole or in part, and is not under consideration by any other journal.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Originality and concurrent submission"}},{"value":"We adhered to the STROBE reporting guideline for cohort studies. A completed STROBE checklist is provided as a supplementary file with the submission.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Reporting checklist"}},{"value":"The authors have no relevant financial or non-financial interests to disclose.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"316"}}