The neuro-ophthalmology of head trauma

Lancet Neurol. 2014 Oct;13(10):1006-16. doi: 10.1016/S1474-4422(14)70111-5.

Abstract

Traumatic brain injury (TBI) is a major cause of morbidity and mortality. Concussion, a form of mild TBI, might be associated with long-term neurological symptoms. The effects of TBI and concussion are not restricted to cognition and balance. TBI can also affect multiple aspects of vision; mild TBI frequently leads to disruptions in visual functioning, while moderate or severe TBI often causes structural lesions. In patients with mild TBI, there might be abnormalities in saccades, pursuit, convergence, accommodation, and vestibulo-ocular reflex. Moderate and severe TBI might additionally lead to ocular motor palsies, optic neuropathies, and orbital pathologies. Vision-based testing is vital in the management of all forms of TBI and provides a sensitive approach for sideline or post-injury concussion screening. One sideline test, the King-Devick test, uses rapid number naming and has been tested in multiple athlete cohorts.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Accommodation, Ocular
  • Athletic Injuries / diagnosis
  • Athletic Injuries / physiopathology
  • Brain Concussion / complications
  • Brain Concussion / physiopathology
  • Brain Injuries / complications
  • Brain Injuries / physiopathology
  • Craniocerebral Trauma / complications*
  • Craniocerebral Trauma / pathology
  • Craniocerebral Trauma / physiopathology*
  • Eye Injuries / complications*
  • Eye Injuries / pathology
  • Eye Injuries / physiopathology*
  • Humans
  • Neurology
  • Neuropsychological Tests
  • Nystagmus, Physiologic
  • Ophthalmology
  • Ophthalmoplegia / etiology
  • Pursuit, Smooth
  • Reflex, Vestibulo-Ocular
  • Vision Disorders / etiology*
  • Vision Disorders / physiopathology*