![]() before realising it was a re-branded Audeze Mobius. I actually did the research and bought it. Anyway - I digress after returning the SteelSeries, I took a plunge on this (HyperX Cloud Orbit S), a considerably more expensive headset. however I can categorically confirm that this headset is plagued by a bug which causes it to randomly disappear from your devices when not in use (making you have to unplug and re-connect the headset) I reached out to the good folks at SteelSeries and they said this is a known issue (and has been since last year). I originally bought a SteelSeries Arctis Pro + Game DAC. I (like most of us) am isolating currently and I thought I would treat myself to a new gaming headset to better enjoy the experience (and not annoy the other half - which is equally if not more important). I thought that I would write a review for this product as I was very impressed. ![]() To learn more about how and for what purposes Amazon uses personal information (such as Amazon Store order history), please visit our Privacy Notice. You can change your choices at any time by visiting Cookie Preferences, as described in the Cookie Notice. Click ‘Customise Cookies’ to decline these cookies, make more detailed choices, or learn more. Third parties use cookies for their purposes of displaying and measuring personalised ads, generating audience insights, and developing and improving products. This includes using first- and third-party cookies, which store or access standard device information such as a unique identifier. If you agree, we’ll also use cookies to complement your shopping experience across the Amazon stores as described in our Cookie Notice. We also use these cookies to understand how customers use our services (for example, by measuring site visits) so we can make improvements. We use cookies and similar tools that are necessary to enable you to make purchases, to enhance your shopping experiences and to provide our services, as detailed in our Cookie Notice.
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This collection of rough iron widgets and doodads can be used to construct practical, sturdy machinery. Identical in name to an unused throwable weapon. Previously believed to be lost in the Dwarven Panini Mines during a particularily odd balrog invasion, the fabled Dwarven Panini Press can be used to grill many things, including an entire elf. Magnesium - one of the three the Forbidden Metals. One could not ask for a more splendid source of magnesium. Unimplemented, but next to these, is a single comment with the idea of The voltaic amulet consists of a small, metal beehive full of deadly electric shock bees. It's an amulet shaped like a fish and smelling like one too. The blue amulet is commonly regarded as the most peaceful and soothing of amulets. This plastic amulet was released in a limited edition collector's run of 50,000. Once you had true love, and it was a gas, but now all that's left is this amulet of glass. The angsty amulet cries itself to sleep every night, and leaves little blood-stained notes on your pillow. The cyan amulet: a colour only a toner cartridge replacement expert could love. The amber amulet makes for delightful neckwear and may contain dinosaurs. This amulet is made from the many fauceted scarlet emerald first stolen by Grignr the Barbarian. Next to these unused items are some brief notes from the developers on potential future throwable potions. No matching sprite can be found for the name given. Likely from an early stage in development as the item definition lists 3 unused attributes, crit (2), dmgMin (31) and dmgMax (31). Previously believed to be lost in the Dwarven Panini Mines during a particularily odd balrog invasion, the fabled Dwarven Panini Press can be used to grill many things, including faces. Put it on your salad for a delicious dish, or dump it on your enemies for fiery vengeance.Ĭommented out with the comment "Oil isn't happy right now." Likely from an early stage in development as the item definition lists 3 unused attributes, crit (2), dmgMin (29) and dmgMax (29). This flail comes from a world of hurt and, quite appropriately, it sends its victims to its place of manufacture. The level value represents the level of the Dungeon that the item most commonly spawns on. Found within the game's itemDB.xml files are commented out definitions of items many even still have sprites! ![]() This can lead to Code Execution because some of the commands have options that can be leveraged to run arbitrary executables. However, there is the possibility that a user input starts with a dash (`-`) and is therefore treated as an optional argument instead of a positional one. When building the commands, Poetry correctly avoids Command Injection vulnerabilities by passing an array of arguments instead of a command string. These commands are constructed using user input (e.g. When handling dependencies that come from a Git repository instead of a registry, Poetry uses various commands, such as `git clone`. Poetry is a dependency manager for Python. On XWiki versions 12.0 and later, it is also possible to import the document `XWiki.XWikiServerClassSheet` from the xwiki-platform-wiki-ui-mainwiki package version 14.4 using the import feature of the administration application as there have been no other changes to this document since XWiki 12.0. As a workaround, edit the affected document `XWiki.XWikiServerClassSheet` or `WikiManager.XWikiServerClassSheet` and manually perform the changes from the patch fixing the issue. This has been patched in versions 13.10.6 and 14.4. Also, this could be used to impact the availability of the wiki. This allows arbitrary Groovy/Python/Velocity code execution which allows bypassing all rights checks and thus both modification and disclosure of all content stored in the XWiki installation. Starting with version 5.3-milestone-2 and prior to versions 13.10.6 and 14.4, it's possible to inject arbitrary wiki syntax including Groovy, Python and Velocity script macros via the request (URL parameter) using the `XWikiServerClassSheet` if the user has view access to this sheet and another page that has been saved with programming rights, a standard condition on a public read-only XWiki installation or a private XWiki installation where the user has an account. XWiki Platform Wiki UI Main Wiki is software for managing subwikis on XWiki Platform, a generic wiki platform. ![]() The Footlight Players, Charleston’s longest producing theatre company, celebrates eighty-two years of continuous theatre as the legend of King Arthur and his Knights of the Round Table comes alive on the Dock Street Theatre stage in the Lerner and Loewe classic, Camelot. What began as a small group has become, for Charleston, a theatrical tradition, built and strengthened over many years by hundreds of willing hands, by priceless gifts of time and toil,and of faith, enthusiasm and talent, freely offered and in gracious abundance.“Camelot” at the Footlight Players Theatre August 2 - 18, 2013ĭock Street Theatre, 135 Church Street, Charleston, SC 29401 No cut-and-dried record of growth statistics, no matter how comprehensive, can tell the true story of the Footlight Players. Since 1931,through depression, wars, recessions, and natural disasters, the Footlight Players have been in continuous production. The second is that a community theater best serves its audiences by being truly indigenous, with the selection of plays and styles of presentation strongly influenced by the mores and attitudes of the town. The first is that plays of professional caliber can be produced on a community level. In 1986 the Footlight Players moved out of the Dock Street Theater and has presented the six-show season in the Footlight Players Workshop exclusively.įor over six decades, two principles have dominated the growth of the Footlight Players, Inc. Since that time - the fall of 1941 - the Footlight Players has presented six regular seasonal productions annually, both in the Workshop and in the Dock Street Theater. In less than two months through the efforts of volunteer workers of all ages, the former warehouse was completely remodeled to emerge as an informal playhouse and workshop. Still but four walls and a roof (on which was a debt for damages inflicted by a recent tornado) they visualized its possibilities as a Workshop. At that time in 1941 there were no theaters available for rental so the Footlight Players turned again to their warehouse. In 1938 began a three-year period during which an affiliation was in effect between the Footlight Players and the Carolina Art Association, which terminated in 1941. ![]() In November 1937, upon invitation of the City of Charleston, the Footlight Players opened the reconstructed Dock Street Theater with a special gala production of "The Recruiting Officer". Several plays were presented alfresco and the Victory Theater was used from December 1936 to April 1937. It was in the old Academy of Music that most of these early plays were presented until 1936 when a Footlight production closed the history of this famous Charleston landmark, the building then being razed after 70 years of theatrical activity. Yet until 1938, all productions were given in rented theaters, and the warehouse was used for storage and scenery construction. ![]() ![]() In 1934, the Footlight Players purchased an old cotton warehouse at 20 Queen Street with the idea of eventually converting it into a finished playhouse. Reflecting this spirit, in March 1931, a small group presented a program of one-act plays, and so started the history of this company, formally organized as "The Footlight Players, Inc." in the fall of 1932. Heirs to a tradition dating back to the early 19th century, a nucleus of Charlestonians wanted a truly community theater for their city. Charleston's oldest community theater group, the Footlight Players had their beginnings sixty years ago. ![]() Try it for free here.Īs with any third-party software, it’s essential to ensure that your disk analyzer comes from a reputable developer through a reliable channel. But there is another tool I can’t help but recommend when talking about Mac device cleanup.Ī full-featured toolkit like CleanMyMac X combines a DaisyDisk-like Space Lens module with a broader range of tools, such as Smart Scan, effective Uninstaller, System Junk cleaner, and comprehensive Malware Removal. This tool will help you organize space on your Mac more wisely and identify the heaviest folders. Plus, building up a couple of gigabytes of junk in the collector before hitting the delete button feels like a real accomplishment.ĭaisyDisk is good at representing and deleting files from your disk. DaisyDisk makes things look and feel friendlier and makes the deletion process fast and easy. Because it deals with the deeper structures of your Mac, disk analyzers can be a little intimidating. This helps ensure a smooth and pleasant workflow. Every click leads to a seamless reaction, and both the “quick scan” and standard scan functions work at an impressive pace. DaisyDisk, by contrast, is fast and fluid. It’s fast! Some disk analyzers can get slow because of the amount of data they have to sift through.The color contrasts also help illustrate the relations between different areas of your Mac. At a glance, it lets you see which files are taking up the biggest “slice of the pie,” which makes exploration easy and pleasing to the eye. The candy-colored wheel the app uses to represent your disk is visually engaging and easy to understand. DaisyDisk is one of the nicest-looking disk analyzers available.And some make intelligent suggestions about what you should delete.ĭaisyDisk distinguishes itself from the pack with its stunning visual design, speed, and ease of use. ![]() Some combine the analyzer with lots of other tools. There are plenty of disk space analyzers out there, all jockeying for being the one for you. It can help guide your disk cleanup by flagging purgeable areas and smaller orphaned items suitable for deletion. When you’ve collected all the trash DaisyDisk has identified on your drive, hit the Delete button to take it out.ĭaisyDisk is capable of offering valuable suggestions about which files can be deleted to free up more space. The app keeps a running count of how much space you’ll free up and presents you with a delete button. You can drag and drop any file here to target it for deletion. The app’s most satisfying feature is the file collector, which appears as a large dot in the bottom left corner. If you know what you’re looking for, the Scan Folder tool lets you focus on individual folders without digging through the main interface. It can give you a definitive breakdown of any drive connected to your computer, including external hard drives and backup disks. A series of tabs at the top of the screen lets you zoom back out with ease whenever you need it.ĭaisyDisk isn’t limited to analyzing your Mac’s hard drive. It gives you a clear idea of file names, folders, and sizes for easy reference. The main display is equally easy to navigate using the file list on the right-hand side of the screen. Navigation is a snap: clicking on a display section zooms in and creates a new circular layout showing the chosen files in more detail. The display is color-coded, so you can easily distinguish between different data types. Let me tell you a bit about what features it is famous for:ĭaisyDisk uses an innovative circular design to show you those files that take up space on your Mac. The deletion is permanent - the deleted files cannot be restoredĭaisyDIsk packs a lot of functionality into a beautiful package. The possibility to connect and scan multiple disks (including external hard drives or a startup disk) Manual deletion of files, which may result in losing vital information The scan covers different types of files (including the hidden ones) and is fast The limited functionality of the free trial version Because I’m generally intimidated by super techie stuff, I chose a more colorful and easy option, DaisyDisk, for a test drive. There are many options of disk analyzers out there, from the highly technical to the user-friendly ones. These apps create a detailed map of what files are taking up room on your hard disk, making it easier to see where you can save space. The solution comes from a specific utility app called a disk analyzer. The problem is that most digital junk is well-hidden and shattered around your system. ![]() Imagine how much memory you can free up if you get rid of all that junk. Think about it.300MB here, 500MB here, 1GB there.soon, all the extra files become a toxic load on your computer. The longer you use your computer, the more junk files and caches build up on your hard disk. If you’ve noticed that your Mac is a little sluggish lately, the culprit may be hiding in plain sight. There’s a ton of cream pie pornos from the major studios, starring the girls you’ve already been jacking off to. Just because it’s free doesn’t mean it’s bullshit. Those dudes in bukkake flicks are really wasting their loads, don’t you think? Get those teens pregnant as fuck! Why stop at one pop? You can find bitches getting double-creampied in threesomes, or going all out in orgies that leave them leaking like a jug of milk dumped on its side. What’s your creampie fantasy? Wish you had a French maid, or are you more of an incest fantasy guy? Be careful with that latter one-we don’t want any inbred, one-eyed monster babies popping out 9 months later! You may not be able to pop your cork inside of your nurse, your secretary, your babysitter, or your teenage stepdaughter, but you can live vicariously through the videos on these sites. ![]() ![]() What kind of girl do you want to see get cum in her pussy? You can watch the girl of your wettest dreams get pumped full of hot seed on these sites! They’ve got accidental creampies and fully intentional fill-ups, so take your pick. What kind of (HD) creampie & impregnation porn videos can I watch on these sex tubes?Man, it’s like a goddamn puppy mill on these porn sites because there is all kinds of breeding going on! You’ve got beautiful blondes and brunettes breeding with huge-cocked dudes, teens, and MILFs breeding with well-hung men, not to mention all the Latinas, Asians, and Ebony chicks breeding with guys who have enormous genitalia. They say there’s no such thing as a free lunch, but how about dessert? That’s fewer strings attached than that fat girl at the bar who swears she’s on birth control. Hell, I’ve even made sure to choose free creampie tubes that won’t blow up your browser with dick-pill ads and those horny local single ads that never work out for you. You can dive in right into that creamy filling right now, no waiting, and it won’t cost you a goddamn thing. I’ve got a better creampie recipe than your grandma, God rest her soul, and you don’t even have to go buy a pie crust or wait for that bad boy to chill in the fridge. Well, you’re in for a treat, my sweet-loving friend. Our survival as a species pretty much depends on you getting rock hard at the thought of squirting some of your own personal baby juice into every tight, wet incubator you can lay your dick on. You want to see crisp, clear videos of the hottest pornstars and sexiest amateurs getting filled with cum, uncut and uncensored. ![]() What kind of retard would ask for expensive, low-res porno movies that cut off right when the dude starts nutting inside a broad? You want the good shit, just like everybody else. I want to see free (full-length) 720p/1080p/4K HD creampie porn videos of girls begging to cum inside!That’s no surprise at all. ![]() 3840x2400px Dirt Rally 2, poster, 2019 games, autosimulator, Volkswagen Polo GTI, HD wallpaper.1080x1847px Rallycross, carros, drifting, rally, subaru, HD phone wallpaper.IPhone Xs Max, iPhone 11 Pro Max: 1242x2688 IPhone X, iPhone Xs, iPhone 11 Pro: 1125x2436 IPhone 6 plus, iPhone 6s plus, iPhone 7 plus, iPhone 8 plus: 1242x2208 IPhone 6, iPhone 6s, iPhone 7, iPhone 8: 750x1334 IPhone 5, iPhone 5s, iPhone 5c, iPhone SE: 640x1136 IPhone: iPhone 2G, iPhone 3G, iPhone 3GS: 320x480 IPhone 12 mini, iPhone 13 mini: 1080x2340 1332X850 Wallpaper machine, forest, speed, drift, DiRT Rally 2.0 images for desktop, section - download. IPhone 12 Pro Max, iPhone 13 Pro Max: 1284x2778 2560X1600 40+ Dirt Rally Wallpaper on WallpaperSafari.ġ920X1080 DiRT Rally, Video Games Wallpapers HD / Desktop and Mobile Backgrounds. IPad 3, iPad 4, iPad Air, iPad iPad, iPad Mini 2, iPad Mini 3, iPad Mini 4, 9.7" iPad Pro: 2048x1536, 1536x2048 1366X768 DIRT RALLY WALLPAPER PRO Rally Dakar Rally motorcycle FIA world rally dirt bike Hyundai i bikes WRC dirt road KTM racing race KTM 450 Rally Factory Ready for the 2022 WRC season, the Ford Puma Hybrid Rally1 is the brands first ever electrified race car. Utilising a hybrid setup consisting of a 1.6L inline 4 cylinder engine producing 380 hp and 420 Nm on it's own, and a battery powered electric motor capable of outputting 100 kW. The electric motor only provides a boost in power for a. 3200x1800px dirt rally 2.0, volkswagen, racing games, Games, HD wallpaper.1920x1080px Dirt, DiRT Rally 2.0, HD wallpaper.3840x2160px Dirt, DiRT Rally 2.0, HD wallpaper.3543x5315px rally, motocross, dirt bike, reflection, water, esports, HD phone wallpaper.5669x3188px Dirt Rally 2 2019, dirt-rally-2, 2019-games, games, racing, carros, volkswagen, HD wallpaper. ![]() 2560x1600px dirt rally, simulator, race, HD wallpaper.4000x2667px Dirt Road Into The Forest, HD wallpaper.2048x1520px Father And Sun On Dirt Road, HD wallpaper.2560x1600px DiRT 4, car simulator, rally, Ford Fiesta, HD wallpaper.950x1585px Dirt 3 Rally Race, HD phone wallpaper.2300x4400px Biker, dirt bike, HD phone wallpaper.Explore a curated colection of Dirt Rally Wallpaper Images for your Desktop, Mobile and Tablet screens. 3840x2160px Playerunknown's Battlegrounds 2.Now that you know how it’s done, you can spice up your Home screen and Lock Screen with a few quick taps.We've gathered more than 5 Million Images uploaded by our users and sorted them by the most popular ones. With the abundance of options your iPhone XS Max offers, your wallpaper and screen saver will never have to be boring again. Pick the mode and choose where you want to set the wallpaper. If it is a live photo, you will also be able to choose the Live mode. If it is a regular photo, the phone will let you choose between the Still and Perspective modes.Find the “Set as Wallpaper” option and tap on it. The “Sharing” menu will open near the bottom of the screen.It is located in the bottom-left corner of the screen. Next, navigate to the photo of your choice and tap on it.Pick the folder which contains the photo that you want to use and tap on it. Once the app opens, it will show you a list of folders.On the Home screen, tap the “Photos” app icon.In this method, you will change your wallpaper using your phone’s photo library. Note that you won’t have to confirm your choice, as the wallpaper will be set automatically. Choose the one that you want and tap on it. Your iPhone XS Max will then offer you three options – “Lock Screen”, “Home screen”, and “Both”. On the preview screen, choose one of the available modes (Still, Perspective, Live) and tap “Set”. Next, choose a wallpaper from the menu and tap on it. Once you’ve decided on the type (Stills/Dynamic/Live), tap on its picture. Conversely, it will revert to its original position once you lift your finger from the screen. In the Live mode, it will move when you touch the screen. With the perspective option, it will move as the phone is tilted, just like a still image in the perspective mode. If you opt to set a live wallpaper as a still, it will not move. The live wallpapers are the third variety. In the still mode, the image doesn’t move. In the perspective mode, the image moves as you tilt the phone, making it look like the wallpaper is further back and you’re seeing it through a window. With them, you can opt between perspective and still modes. The stills are, as their name suggests, still images which you can set as wallpapers. ![]() Furthermore, it’s possible to add files straight from cloud storage services like Google Drive, Dropbox, and OneDrive. It supports over 200 different file formats for conversion, including PNG, JPG, GIF, WEBP, and many others. When it comes to converting multiple file-formats, CloudConvert is the perfect option. If you select 100 percent, the image quality will not be affected. Moreover, you get the option to maintain the quality of the output images. It also rotates photos 90 degrees and produces output files that are substantially larger. Plus, you may appreciate its conversion speed as well as the infinite batch conversion capability. The FonePaw HEIC Converter is another useful free program that can convert all of the images you shot with your iOS device into more common file formats like JPEG and PNG in different quality levels. The best part about this tool is that it deletes your uploaded files once the conversion is complete so you don’t need to be concerned about the privacy of your data. There is a limit of 60 pictures that may be converted at the same time. You may also change the image quality using a simple slider. You may use this to convert personal images or bunches of photos from HEIC to JPEG, with the option of removing all EXIF data from the new files. Apowersoft Free HEIC ConverterĪpowersoft is another easy-to-use and free HEIC converter. It is compatible with both Windows and MacOS. Once the conversion is finished, the iMobile HEIC converter does not meddle with your EXIF files and gives you three image quality options to pick from. IMobile HEIC converter is a free online HEIC to JPG converter that allows you to convert both single and multiple images from HEIC to JPG, PNG, or GIF format with a simple drag and drop. Platforms: Browser/website, macOS, Windows The other best aspect is the ad-free interface that allows you to download images with a single click. Plus, you can see the size of the input HEIC and output JPG images on the site. After conversion, the photos are fully optimized. The HEICtoJPEG online converter can convert up to 200 images. To collect files for conversion, it uses the standard drag-and-drop approach. Its most notable feature is that it generates a URL address for the image you want to convert and transforms it really quickly. ![]() This is a free and simple online HEIC to JPG converter. As a result, there’s no need to be concerned about the output file’s quality. One of the most useful features of iMazing is that it saves EXIF metadata and supports color profiles such as wide-gamut. ![]() With a simple interface, you can easily convert HEIC to any other image format through a simple drag and drop feature. It is free and compatible with both macOS and iOS devices. IMazing is one of the best HEIC to JPG converter software. Let’s have a look at some of the best tools for converting HEIC to JPG. If you want to convert HEIC images to JPG, you can do it easily using some tools on the Internet for converting images from one format to another. Many users have capacity concerns on their iOS devices and so Apple devised this format to preserve space. The main reason Apple uses the HEIC format is to save space on iOS devices. It takes up less space and produces images of outstanding quality. When comparing the HEIC and JPG formats, we may conclude that HEIC is superior. Simply said, it is a container for storing single or many picture files. HEIC is an abbreviation for High-Efficiency Image File format. Fastest Way to Convert Images to Other Formats on Macĭid you know that you can convert images from one format to another natively on your Mac, that. ![]() Can the new generation of Shrek’s Seven Devils rally the Tang Sect and once more compose the song of the Unrivaled Tang Sect?Ī million-year-old spirit beast, a sacred deathgod that holds the sun, the moon, and the stars in his hands, and a brand new spirit tool system which caused the fall of the Tang sect. The series was first broadcast on TVB Jade in Hong Kong in 1986. Read THE HEART DRIFTING AFAR WITH THE FLOW (Song from Heaven Sword Dragon Sabre 1986) from the story Song Lyrics from The Condor Trilogy TV Series ( all. A new, proud generation of heaven’s chosen has been born. Heavenly Sword and Dragon Slaying Sabre Original title: Yitian tulongji TV Series 2019 45 m IMDb RATING 7.8 /10 290 YOUR RATING Rate Drama Chinese television series adapted from the Louis Cha novel, which is the third part of the Condor Trilogy. New Heavenly Sword and Dragon Sabre is a Hong Kong television series adapted from Louis Cha 's novel The Heaven Sword and Dragon Saber. Windows 11 Pro Retail Keys at 4.99 USD Only Get Your Windows 11 activated at 4.99 only. Click here to Magnet Download the torrent. Ten thousand years have passed since the founding of the Tang Sect on the Douluo continent, and it has declined. Torrent: Heavenly SwordDragon Saber (42.2 GB) Has total of 50 files and has 6 Seeders and 65 Peers. ![]() A powerful and subtle aura gushed out from his robe. It sounds simple, but it s actually extremely difficult. ![]() There is no magic, no battle qi, nor any martial arts in this land. It was a long river of sword energy that suddenly appeared under the sky, and then wandered for a moment, like a thousand swords, all descending at the same time. The legend of the continent, the battle that brought fame the Sacred Phoenix Lady, the Windfire Meteor Godrealm saber-art the pair that ascend and fuse, the golden sun and the blue moon, the fury of the crashing thunder. ![]() Such tests, by virtue of their simplicity, objectivity, and reproducibility have served to remove ambiguity from a situation fraught with emotion and potential controversy. It is recommended that the tests are carried out twice, usually a few hours apart. If no respiratory effort is seen with a Pa CO 2 >6.65 kPa (50 mm Hg), it can be assumed the patient is brainstem dead. 5 The ultimate test of brainstem function is the test for apnoea. The bulk of the cranial nerve nuclei lie in close proximity to each other in the brainstem allowing for testing of this structure level‐by‐level (Fig. Third, the absence of brainstem reflexes including the pupillary response to light must be demonstrated. Second, reversible causes of coma such as drug intoxication, hypothermia, metabolic, and endocrine disturbances must be excluded. First, certain preconditions must be met showing the patient suffers from a condition that has led to irremediable brain damage. To make the diagnosis of brainstem death, a three‐stage procedure must be applied. Strict criteria were laid down for the diagnosis, which could confidently be made at the bedside, without the need for special investigations such as an EEG or cerebral angiography. Death was defined as ‘the irreversible loss of the capacity for consciousness combined with the irreversible loss of the capacity to breathe’. In 19, the Conference of Medical Royal Colleges and their Faculties in the UK introduced and developed the concept of brainstem death as being synonymous with the death of the individual, even in the presence of functioning organ systems. Post‐mortem examination revealed a 200 ml subdural haematoma over a swollen left cerebral hemisphere with cerebellar tonsillar herniation and necrosis. The patient’s organs were used for transplantation. ![]() Throughout this period, the pupils remained active, but unresponsive to light. Subsequently, two further sets of brainstem tests were performed and the patient was declared brainstem dead more than 24 h after the first set of brainstem death tests. An EEG showed no cerebral activity, even during stimulation. No mydriatics had been used at any point. At the time when one pupil was constricted, the other pupil was almost maximally dilated and vice versa (Fig. The constriction phase lasted 2.5 s, and the dilatation phase 10 s, giving a periodicity of 5 min –1, which was unrelated to ambient light. They displayed continuous and independent cyclical constriction and dilatation. ![]() The pupils were mid‐dilated and unequal, with the left pupil being larger. They were continuously observed for a period of 10 min and recorded on video. On re‐testing, the pupils were found to be active, but not in response to light. It was decided to re‐test the patient after a 12 h interval. All the brainstem reflexes as laid down in the UK guidelines 1 – 4 were absent apart from the pupillary responses: the pupils were recorded as reacting to light with a consensual response. In view of these findings, and a significantly deranged clotting profile frequently seen in head injuries (APTT 87 s, INR 3.3), a decision was made not to proceed with surgery.Īfter excluding potentially reversible causes for coma, the first set of brainstem death tests were performed approximately 6 h after admission. On arrival at the neurosurgical centre, 3 h after the first presentation, both pupils were fixed and dilated, with absent cough and gag reflexes. Mannitol and vitamin K were administered and she was referred to a regional neurosurgical centre. A computed tomography (CT)‐scan showed a large left subdural haematoma with significant midline shift (Fig. The left pupil was fixed and dilated and the right pupil mid‐dilated and reacting sluggishly to light. On admission, she was unresponsive to command with a Glasgow Coma Score of 4/15, and required immediate tracheal intubation and mechanical ventilation of the lungs. The following morning, she again complained of a sudden headache and collapsed 30 min later. The previous evening she had drunk one and a half bottles of wine and had complained of a sudden frontal headache. Case reportĪ 35‐yr‐old woman, with a history of alcohol abuse and depression, for which she had been prescribed amitryptiline, was referred by her general practitioner to the accident and emergency department with a provisional diagnosis of subarachnoid haemorrhage. Finally, it is important that brainstem death is recognized early to ensure the most efficient use of limited intensive care unit resources. Organ donation, where applicable, is delayed and may affect the suitability of organs for transplantation. For the relatives, the delay in diagnosis results in undue distress. We present a unique case of abnormal pupillary movements in a patient who otherwise fulfilled the criteria for brainstem death. Accepted for publication: January 4, 2001 |