Neuro-Ophthalmic Manifestations of Head Trauma and Predictive Factors.

Lee, Dong Wook

Original Article

Journal of the Korean Ophthalmological Society 2005;46(3):422-428.
Published online March 31, 2005.

Neuro-Ophthalmic Manifestations of Head Trauma and Predictive Factors.

Dong Wook Lee

Department of Ophthalmology, Chonbuk National University, College of Medicine, Jeonju, Korea. dwlee1970@yahoo.co.kr

두부외상 환자에서 발현되는 신경안과적 질환과 예측인자

이동욱

Department of Ophthalmology, Chonbuk National University, College of Medicine, Jeonju, Korea

Correspondence: Dong-Wook Lee, M.D.

Abstract

PURPOSE
To describe the neuro-ophthalmic findings in a group of patients with head trauma. METHODS: A retrospective chart review of all patients who were given a diagnosis code of cerebral concussion and cerebral contusion in a hospital between 1995 and 2003. A total of 1284 consecutive patients were reviewed (972 [76%] men and 312 [24%] women). The mean age was 40.36 years. Motor vehicle accident was the most common cause of head trauma, occurring in 944 (74%) patients. RESULTS: Ophthalmological examination was undertaken in 308 (24%) head trauma patients and an abnormal neuro-ophthalmic examination result was noted in 122 patients (9.5% of total patients, 40% of ophthalmologically examined patients). Traumatic optic neuropathy was the most common manifestation, followed by oculomotor, abducens, trochlear, facial nerve palsy, Terson syndrome and internuclear ophthalmoplegia. Loss of consciousness and cerebral concussion were not associated with any outcomes, but the presence of neuroimaging (computed tomography, magnetic resonance imaging) abnormality, particularly intracranial hemorrhage and skull fracture, was significantly associated with neuro-ophthalmic deficits. CONCLUSIONS: Head trauma causes a number of neuro-ophthalmic manifestations. Intracranial hemorrhage and skull fracture may be a reliable predictor of specific neuro-ophthalmic outcomes.

Key Words: Head trauma;Loss of consciousness;Neuroimaging abnormality;Neuro-ophthalmic findings