Specialties CCU
Published Dec 10, 2012
danmarin_99
7 Posts
First a little information about the patient: the patient is currently intubated receiving both propofol and Ativan. Among other medications; Dilantin and morphine. This patient is also a recreational drug user at home of both cocaine and Xanax. My question is: in assessing their neurological status, I was checking the response to light and the patient's pupils contract AND relax rhythmically several times until the light is taken away. They do not fix at a particular mm. I figure it is a response to the drugs and I received in report that this is a known thing, but I am curious if anyone else has seen this.
WSU_Ally_RN, BSN, RN
459 Posts
Yep, it's called hippus... I've seen it a few times in my carreer... here's a wikipedia article about it :)
Hippus - Wikipedia, the free encyclopedia
From what our doc's tell us, its usually a normal finding, they never seem to be concerned when I find this in one of my kiddos.
Esme12, ASN, BSN, RN
1 Article; 20,908 Posts
It can also be drug induced.
Hippus is visible, rhythmic, but irregular pupillary oscillations that are deliberate in time. It comprises 2 mm or more excursions and has no localizing significance. 1. Normal 2. Incipient cataracts 3. Central nervous system diseases, including the presence of total third cranial nerve palsy, hemiplegia, meningitis (acute), cerebral syphilis, tabes, general paralysis, myasthenia gravis, tumors of corpora quadrigemina, epileptics, Cheyne-Strokes breathing, multiple sclerosis (disseminated sclerosis), and cerebral tumors 4. Neurasthenia (nervous exhaustion, Beard disease) 5. Drugs, including the following:[TABLE][TR][TD]allobarbital amobarbital aprobarbital barbital butabarbital butalbital butallylonal butethal cyclobarbital [/TD][TD]cyclopentobarbital heptabarbital hexethal hexobarbital mephobarbital metharbital methitural methohexital pentobarbital [/TD][TD]pentylenetetrazol phenobarbital primidone probarbital secobarbital talbutal thiamylal thiopental vinbarbital [/TD][/TR][/TABLE]http://telemedicine.orbis.org/bins/volume_page.asp?cid=1-2897-3604-3612
1. Normal
2. Incipient cataracts
3. Central nervous system diseases, including the presence of total third cranial nerve palsy, hemiplegia, meningitis (acute), cerebral syphilis, tabes, general paralysis, myasthenia gravis, tumors of corpora quadrigemina, epileptics, Cheyne-Strokes breathing, multiple sclerosis (disseminated sclerosis), and cerebral tumors
4. Neurasthenia (nervous exhaustion, Beard disease)
5. Drugs, including the following:
[TABLE]
[TR]
[TD]allobarbital
amobarbital
aprobarbital
barbital
butabarbital
butalbital
butallylonal
butethal
cyclobarbital
[/TD]
[TD]cyclopentobarbital
heptabarbital
hexethal
hexobarbital
mephobarbital
metharbital
methitural
methohexital
pentobarbital
[TD]pentylenetetrazol
phenobarbital
primidone
probarbital
secobarbital
talbutal
thiamylal
thiopental
vinbarbital
[/TR]
[/TABLE]
http://telemedicine.orbis.org/bins/volume_page.asp?cid=1-2897-3604-3612
[TD][/TD]
Excellent! Thank you so much for this information. As I suspected, it is indeed drug induced.