Ocular manifestations of head injury and incidence of post-traumatic ocular motor nerve involvement in cases of head injury: a clinical review

Sharma, Bhavana; Gupta, Rachna; Anand, Ravi; Ingle, Rashmi

doi:10.1007/s10792-014-9898-8

Cited by 33 publications

(27 citation statements)

References 18 publications

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“…The commonest intraocular manifestation following soft tissue injury to the globe and adnexa included ecchymosis in 10 patients, which was the commonest ocular manifestation in our study (26.31%), subconjunctival haemorrhage in 4 patients (10.5%). This was a similar observation in studies by Sharma B et al 12 (51.85%, 44.44%), Kulkarni et al 11 (27%, 19%), To Odebode et al 9 (21/57, 17/57). In our study, none of the orbital fractures resulted in enophthalmos, strabismus or globe rupture.…”

Section: Discussionsupporting

confidence: 90%

“…Majority of patients in our study were males and were in 20-30 years age group. This was similar observation in studies by TO Odebode et al 9 (47.36%) in Nigeria, Van Stavern et al, 10 Kulkarni et al 11 (62%), Sharma B et al 12 (67.4%). This prominence of head injuries in young adult male population could be due to their active outdoor and travelling lifestyle.…”

Section: Discussionsupporting

confidence: 88%

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Ocular Manifestations of Head Injuries

Rao¹,

Kumari²

2016

jebmh

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BACKGROUND This prospective study aimed to evaluate the incidence of ocular manifestations in head injury and their correlation with the intracranial lesions. MATERIALS AND METHODS A total of 108 consecutive cases of closed head injury admitted in the neurosurgical ward of a tertiary teaching hospital underwent a thorough ophthalmic assessment. Clinical examination, radiological imaging and Glasgow Coma Scale (GCS) were applied to grade the severity of injury. RESULTS Total number of 108 patients of head injury were examined of which 38 patients had ocular manifestations (35.18%). Of these, 85.18% were males, 84% of injuries were due to road traffic accidents and 16% were due to fall from a height. The ocular manifestations were as follows-Orbital complications were seen in 6 patients (15.8%). Anterior segment manifestations included black eyes seen in 10 patients (26.3%), subconjunctival haemorrhage in 10.5% of patients (4 patients), corneal involvement in 21% of patients (8 patients) and pupillary involvement in 50% of patients (19 patients). Posterior segment manifestations were seen in 26.3% of patients (10 patients) and were as follows-Purtscher's retinopathy in 2 patients and optic atrophy in 5 patients. Cranial nerve palsies were seen in 15 patients (39.47%) and supranuclear movement disorders were seen in 3 patients (8%). CONCLUSION Even though, neurosurgeons perform comprehensive clinical examination including eye examination, the main purpose is limited to aid topical diagnosis of neurological lesions. This study emphasises the importance of a detailed eye examination by an ophthalmologist to prevent irreversible visual loss in addition to aiding in the neurological diagnosis. Pupillary involvement, papilloedema and ocular motor paresis pointed to a more severe head injury. This observational prospective study helped us to correlate the severity of head injuries in association with ocular findings in patients admitted in neurosurgical ward and in patients reported to Department of Ophthalmology with a history of head injury.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 88%

Ocular Manifestations of Head Injuries

Rao¹,

Kumari²

2016

jebmh

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“…13, 14 One proposed explanation 11 for a higher incidence of fourth nerve palsy in males is that head trauma is more frequent in males. 28–30 Nevertheless, in a series of closed-head injury patients, 31 more of those presenting with fourth nerve palsy were male compared with those presenting with third nerve palsy, suggesting that males are particularly prone to fourth nerve palsy. It is possible that males are more susceptible to specific types of head injury, which might be more associated with fourth nerve palsy.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Etiology of Presumed Fourth Cranial Nerve Palsy: A Population-based Study

Dosunmu

Hatt

Leske

et al. 2018

American Journal of Ophthalmology

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Purpose To determine the incidence of isolated, presumed fourth nerve palsy in a defined population, and to report the frequency of each cause. Design Retrospective, population-based case-series. Methods A population-based database was used to identify all cases of isolated fourth nerve palsy in Olmsted County, MN, USA diagnosed over a 15-year period (January 1, 1978 to December 31, 1992). The most likely etiology was determined by review of the entire medical record by two ophthalmologists. A priori definitions were applied for assigning cause. The incidence of fourth nerve palsy and the frequency of each etiology were calculated. Decade of life at presentation was recorded. Results 73 patients, (74 episodes, 70 [95%] unilateral) were identified. Mean age at presentation was 41.8 (range 3.3 to 81.6) years. The age- and sex-adjusted annual incidence rate was 5.73 per 100,000 per year (95% Confidence Interval [CI] 4.31–7.14). The most common etiology was presumed congenital (49%) followed by hypertension (18%) and trauma (18%). One patient (1%) had fourth nerve palsy due to a known intracranial neoplasm. For 3 patients (4%) the cause of fourth nerve palsy was undetermined. The most common decade of presentation overall was the fourth decade, including for presumed congenital cases. Conclusions In this population-based study, the majority of isolated fourth nerve palsies were presumed congenital, even though they presented throughout adulthood. Other etiologies such as hypertension and trauma were less frequent, and in no case was an isolated fourth nerve palsy the presenting sign of an intracranial tumor.

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“…Infectious, inflammatory and traumatic causes are less likely. [5][6][7][8][9][10][11][12][13][14] In our patient the cause was hematoma due to hemorrhage from cavernoma (arterio-venous malformation).…”

Section: Discussionmentioning

confidence: 99%