title: Neurologist versus machine: is the pupillometer better than the naked eye in detecting pupillary reactivity.
abstract: BACKGROUND
  A 62-year-old man with severe traumatic brain injury developed postsurgical anisocoria in which there was a discrepancy between pupillometer and manual testing.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  The patient's larger pupil was read as unreactive by the pupillometer but constricted 1 mm over 7-9 s of continuous light stimulation.
  
  
  CONCLUSIONS
  While pupillometry assessment is a valuable adjunct to the manual pupillary assessment, this case demonstrates that nonreactive pupils read on the pupillometer should be confirmed with the manual examination because it can miss very slowly reacting pupils.
authors.affiliation: Department of Neurology, Mayo Clinic, Mary Brigh 8-D, 200 First Street SW, Rochester, MN, 55905, USA, kramer.christopher1@mayo.edu.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Kramer
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Rabinstein
authors.forename: Eelco F M
authors.initials: EF
authors.lastname: Wijdicks
authors.forename: Sara E
authors.initials: SE
authors.lastname: Hocker
mesh_terms: D015875:Anisocoria / Q000175:diagnosis*; D003128:Coma / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000295:instrumentation / Q000592:standards*; D012025:Reflex, Pupillary / Q000502:physiology*