Neuro-ophthalmic Analyses of Head Trauma Patients

PURPOSE: To investigate the types and clinical features of neurological diseases after head trauma. METHODS: From March 2010 to December 2018, a total of 177 patients were enrolled in this study. We retrospectively reviewed the clinical features of neurological ophthalmic diagnoses and frequencies, the types of head injuries, and the prognoses. RESULTS: Cranial nerve palsy was the most common (n = 63, 35.6%), followed by traumatic optic neuropathy (n = 45, 25.4%), followed by optic disc deficiency, ipsilateral visual field defect, Nystagmus, skewing, ocular muscle paralysis between nuclei, and Terson syndrome. Neuro-ophthalmic deficits occurred in relatively strong traumas accompanied by intracranial hemorrhage or skull fracture. However, convergence insufficiency and decompensated phoria occurred in relatively weak trauma such as concussion. The prognoses of the diseases were poor (p < 0.05) for traumatic optic neuropathies and visual field defects. The prognoses of neurological diseases were poor if accompanied by intracranial hemorrhages or skull fractures (p < 0.05). CONCLUSIONS: After head trauma, various neuro-ophthalmic diseases can occur. The prognosis may differ depending on the type of the disease, and the strength of the trauma may affect the prognosis.

A week in neuro-ophthalmology: The Singapore experience

Objective@#To report the frequency of neuro-ophthalmologic cases seen over one working week by a senior neuro-ophthalmologist in Singapore and to determine a pattern in the incidence of neuro-ophthalmic diseases.@*Methods@#A retrospective review of 57 consecutive neuro-ophthalmologic cases seen by one senior neuro-ophthalmologist from June 14 to 18, 2010 was done. All patients underwent a complete neuro-ophthalmologic examination. Demographic data and clinical diagnoses were gathered.@*Results@#A total of 57 patients were seen. Thirty-one percent (18) of these patients were new consultations while the remaining 61% (39) were follow-up visits. Fifty-two percent were females (30) with a mean age of 53 years while 47% were males (27) with a mean age of 49 years. Nineteen cases involved disorders of the optic nerve followed by disorders of ocular motility (11), optic chiasm, visual pathways, and/or visual cortex (14). Among the cases involving the optic nerve, 5 were ischemic optic neuropathy. In respect to disorders of ocular motility, ocular myasthenia gravis (n=5) was the most common condition seen. Pituitary adenomas comprised the bulk of the disorders of the optic chiasm (4). The remaining neuro-ophthalmic cases were almost evenly distributed. A very rare case of Froin’s syndrome was also seen.@*Conclusion@#Overall, during the five-day neuro-ophthalmologic clinic, majority of cases were ischemic in nature, reminding readers that systemic diseases, such as hypertension, diabetes mellitus, hyperlipidemia, commonly manifest in the eye. Hence, better systemic control of these diseases is necessary.