Optic nerve injury demonstrated by MRI with STIR sequences

Takehara, Seiya; Tanaka, Tokutaro; Uemura, Kenichi; Shinohara, Yuki; Yamamoto, Takahiro; Tokuyama, Takeshi; Satoh, Atsushi

doi:10.1007/bf00593510

Cited by 25 publications

(7 citation statements)

References 4 publications

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“…Hematomas may not always be insignificant as they can compress the ON if in the right position and of sufficient size. 31 In a retrospective analysis of 354 cases of maxillofacial trauma, 2.25% were diagnosed with TON. The results of which suggested associations between TON and zygomatic, Le Fort II, and cranial bone fractures and radiological evidence of blood in the posterior ethmoidal cells.…”

Section: Discussion Investigationmentioning

confidence: 99%

Traumatic Optic Neuropathy: A Review

Kumaran

Sundar

Chye

2015

Craniomaxillofacial Trauma & Reconstruction

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The aim of this article is to evaluate current literature on investigation and management of traumatic optic neuropathy (TON), propose recommendations for diagnosis and management, and explore novel future treatments. TON, though uncommon, causes substantial visual loss. Without clear guidelines, there is much ambiguity regarding its diagnosis and management. Investigation and treatment (conservative, medical, surgical, and combined) vary widely between centers. Electronic databases PubMed, MEDLINE, PROSPERO, CENTRAL, and EMBASE were searched for content that matched "Traumatic optic neuropathy." Articles with abstracts and full text available, published in the past 10 years, written English and limited to human adults, were selected. All study designs were acceptable except case reports and case series with fewer 10 patients. All abstracts were then evaluated for relevance. References of these studies were evaluated and if also relevant, included. A total of 2,686 articles were retrieved and 43 examined for relevance. Of these, 23 articles were included. TON is a clinical diagnosis. Visual-evoked potential is useful in diagnosis and prognosis. Computed tomography demonstrates canal fractures and concomitant injuries. Magnetic resonance images should be reserved for select and stable patients. Conservative treatment is appropriate in mild TON. Steroids are of questionable benefit and may be harmful. Surgery should be reserved for patients with radiological evidence of compression and individualized.

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Section: Discussion Investigationmentioning

confidence: 99%

Traumatic Optic Neuropathy: A Review

Kumaran

Sundar

Chye

2015

Craniomaxillofacial Trauma & Reconstruction

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“…Some clinicians request CT or magnetic resonance imaging or both for all cases, whereas others limit these investigations to patients with progressive visual deterioration or when therapeutic interventions are being considered. 6 18 19 Before a magnetic resonance imaging is carried out, it is essential to exclude the possibility of an intraorbital or intraocular metallic foreign body by conventional radiography. CT is the best imaging modality for delineating optic canal fractures and their full extent in preparation for possible surgical intervention ( Fig.…”

Section: Neuroimagingmentioning

confidence: 99%

Traumatic optic neuropathy—Clinical features and management issues

Yu‐Wai‐Man

2015

Taiwan Journal of Ophthalmology

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Traumatic optic neuropathy (TON) is an uncommon cause of visual loss following blunt or penetrating head trauma, but the consequences can be devastating, especially in cases with bilateral optic nerve involvement. Although the majority of patients are young adult males, about 20% of cases occur during childhood. A diagnosis of TON is usually straightforward based on the clinical history and examination findings indicative of an optic neuropathy. However, the assessment can be difficult when the patient's mental status is impaired owing to severe trauma. TON frequently results in profound loss of central vision, and the final visual outcome is largely dictated by the patient's baseline visual acuities. Other poor prognostic factors include loss of consciousness, no improvement in vision after 48 hours, the absence of visual evoked responses, and evidence of optic canal fractures on neuroimaging. The management of TON remains controversial. Some clinicians favor observation alone, whereas others opt to intervene with systemic steroids, surgical decompression of the optic canal, or both. The evidence base for these various treatment options is weak, and the routine use of high-dose steroids or surgery in TON is not without any attendant risks. There is a relatively high rate of spontaneous visual recovery among patients managed conservatively, and the possible adverse effects of intervention therefore need to be even more carefully considered in the balance.

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“…Others 42 recommended optic nerve fenestration in the cases of intrasheath haemorrhage detected on MRI scanning. 43 …”

Section: Surgical Treatmentmentioning

confidence: 99%

Surveillance of traumatic optic neuropathy in the UK

Lee

Ford

Xing

et al. 2009

Eye

117

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Aims The aim of this study is to provide epidemiological data on the incidence, aetiology, management, and visual outcome in traumatic optic neuropathy (TON) in the UK. Methods Patients with TON were identified prospectively by population-based active surveillance through the British Ophthalmic Surveillance Unit over a 2-year period with data obtained from an incident questionnaire and follow-up questionnaire sent to positive reporters. Results Incident and follow-up data were available on 121 and 97 (80%) patients, respectively. The minimum estimated incidence was 1.005 per million. Leading causes included falls (25.6%), road traffic accidents (RTAs) (21.5%), and assaults (20.7%). The median age was 31 years. There were 95 (78.5%) men. Presenting visual acuity (VA) was 6/60 or worse in 85 (70%) patients, with 43 patients (36%) with no perception of light. Associated injuries included 47 (39%) orbital wall fractures, 37 (31%) closed globe injuries, 23 (19%) ocular adnexal injuries, 23 (19%) skull fractures, and 18 (16%) intracranial bleeding. Sixty-five percent (75/116) received no acute treatment and 35% (41/116) received steroids and/or surgery. Of the treated group, 24% (8/ 33) and of the untreated group 20% (11/56) improved three lines or more of VA (P ¼ 0.61). Prompt ophthalmic examination (P ¼ 0.002), orbital fracture (P ¼ 0.046), high Glasgow Coma Scale (GCS) score (P ¼ 0.023), and poor initial VA (P ¼ 0.009) were associated with increased likelihood of treatment. Poor initial VA (Po0.001), orbital fracture (P ¼ 0.004), and significant head injury (P ¼ 0.038) were associated with poor visual outcome. Conclusions This study suggested that young men were at greatest risk of TON. We detected a trend towards conservative management of this condition in the UK. TON was associated with significant ocular, orbital, and head injuries that highlighted the need for multidisciplinary management.

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Optic nerve injury demonstrated by MRI with STIR sequences

Cited by 25 publications

References 4 publications

Traumatic Optic Neuropathy: A Review

Traumatic Optic Neuropathy: A Review

Traumatic optic neuropathy—Clinical features and management issues

Surveillance of traumatic optic neuropathy in the UK

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