Probably confusing irritation (epileptic head turning to the other side with pupil dilation) and lesion effects, he suggested a cortical area responsible for oculomotor phenomena, indicating what is now known as the frontal eye field. He distinguished the extent of pressure increase and its duration. In 1880, von Bergmann emphasized the significance of the ipsilateral dilation in experiments as well as in clinical cases. Pagenstecher in 1871 extended knowledge by meticulously studying consecutive pupil phenomena with increasing pressure. Asymmetrical dilation could not always be attributed to increased ICP, but to an oculomotor nerve lesion. Along with bradycardia and motor and respiratory effects, he noticed wide pupils were usually present in a comatose state. Von Leyden's 1866 animal experiments, in which he increased CSF volume by injecting protein solutions intracranially, was the first observation in which the association between fixed dilated pupils and increased ICP was established. Realizing the unreliability of the pupil sign, Hutchinson in 1867-1868 tried to reason in which cases trepanation would be advisable. Bright demonstrated to have some knowledge of the pupil sign (clinical observations). He described dilated pupils in clinical cases without referring to the effect of light. Cooper experimented with intracranial pressure (ICP) in a dog in the 1830s, but did not mention the pupils. Medical and neurological textbooks from the 19th and 20th centuries were reviewed to investigate when and how this information percolated through neurological and neurosurgical practices. Starting from Kocher's standard review in 1901, the authors studied German, English, and French texts for historical information. The aim of this study was to investigate the development of ideas about the nature and mechanism of the fixed dilated pupil, paying particular attention to experimental conditions and clinical observations in the 19th century.
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