Dr. Lawrence Marshall notes that the pupil may become oval or oblong in patients with head injuries and increased intracranial pressure (ICP). In some instances if the ICP was lowered to below 20 mm Hg the oval pupil disappeared. In the cases where ICP could not be controlled the pupil became progressively larger, and finally fixed and unreactive. The football pupil represents a transitional stage indicating transtentorial herniation with third nerve compression. This is a serious sign indicating impending brain-stem compression. Prompt management of the patient's injury is indicated.
J Neurosurg 58:566, 1983.
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