A 2-year prospective surveillance of pediatric traumatic optic neuropathy in the United Kingdom

Ford, Rebecca; Lee, Vickie; Xing, Wen; Bunce, Catey

doi:10.1016/j.jaapos.2012.04.009

Cited by 30 publications

(19 citation statements)

References 14 publications

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“…Traumatic optic neuropathies have been reported in 0.5% to 5.2% of patients after TBI (7,23) with an estimated annual incidence of one case per million among children (11). Although sports-related injuries account for approximately 20% of traumatic optic neuropathies in children (11,13), the authors are not aware of any previously reported cases of coexisting traumatic optic neuropathy and SRC.…”

Section: Discussionmentioning

confidence: 94%

“…In 24% to 90% of adult TBI (2,6) and 29% to 62% of pediatric SRC patients (8), visual disturbances are associated with dysfunction of the vestibular and oculomotor neurological subsystems. In rare cases, however, visual symptoms can occur as a result of direct injury to the visual processing pathways including the optic nerves (11,13,19). Distinguishing between these important causes of visual disturbance in TBI and SRC patients can be challenging but has important implications for prognosis and management.…”

Section: Introductionmentioning

confidence: 99%

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Traumatic Optic Neuropathy

Ellis

Ritchie

Cordingley

et al. 2016

Current Sports Medicine Reports

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Traumatic optic neuropathy is a rare cause of visual disturbance after head injury that can be difficult to distinguish from coexisting vestibulo-ocular dysfunction because of the overlap in presenting symptoms in patients with these conditions. We present a case report of a 13-year-old girl who sustained a head injury during a ringette game leading to blurred vision and diplopia persisting 5 months after injury. Clinical history and physical examination findings were consistent with a traumatic optic neuropathy, convergence insufficiency, and postconcussion syndrome. Neuroimaging was normal. The patient was managed using a multidisciplinary approach. At 6 months of follow-up, neuro-ophthalmological examination demonstrated evidence of permanent partial optic nerve injury, and formal neuropsychological testing fell primarily within normal limits. The patient was advised to retire from collision sports. The authors discuss the value of a comprehensive multidisciplinary approach to the evaluation and management of concussion patients presenting with persistent visual symptoms.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Traumatic Optic Neuropathy

Ellis

Ritchie

Cordingley

et al. 2016

Current Sports Medicine Reports

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“…56 Traumatic optic neuropathy occurs in 0.5%-12% of TBI patients 24,97 with approximately 20% of pediatric cases due to sports-related injuries. 42,46 The clinical presentation of traumatic optic neuropathy can vary from subtle monocular blurred vision or visual field deficits to complete blindness. All patients with suspected cranial nerve injuries affecting vision should be promptly referred to a neuro-ophthalmologist for comprehensive assessment.…”

Section: Discussionmentioning

confidence: 99%

“…Most patients with traumatic optic, oculomotor, trochlear, and abducens neuropathies that present with mild deficits improve with conservative management, while those with complete injuries rarely experience a complete recovery. 42,46,63,88 Despite a relatively good prognosis, there are no evidence-based guidelines to help direct RTP and retirement decision making in these populations. Nevertheless, because of the potential risk of recurrent injury and the significant disability associated with permanent injury, it has been our institutional approach to recommend retirement from contact and collision sports in all pediatric SRC patients presenting with traumatic cranial nerve palsies even after clinical recovery has been achieved.…”

Section: Discussionmentioning

confidence: 99%

Retirement-from-sport considerations following pediatric sports-related concussion: case illustrations and institutional approach

Ellis

McDonald

Cordingley

et al. 2016

FOC

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Neurosurg Focus 40 (4):E8, 2016S portS-related concussion is a form of traumatic brain injury (TBI) that affects millions of North Americans annually. 27,60,73 Historically, SRC has been viewed as a functional disturbance of cerebral metabolism and blood flow that results in temporary alterations in neurological functioning that resolve within 7-10 days. 68,69 More recently, however, increasing attention has focused on the more serious effects of concussion and subconcussive injuries including abnormalities documented on advanced structural neuroimaging studies and the longterm risk of developing cognitive impairment, mood disorders, and neurodegenerative diseases including chronic traumatic encephalopathy (CTE). 7,29,44,48,49,51,65,70,71,80,94,98,99 To mitigate the risks of more serious brain injury following SRC, experts offer consensus statements containing supervised return-to-play (RTP) guidelines that promote the safe return of athletes to the field of play after concussion symptoms have fully resolved. 4,68,69 These guidelines may reduce the risk of second-impact syndrome, a very rare and poorly defined condition thought to arise from loss of cerebral autoregulation and resultant diffuse cerebral edema. 67 However, they do not provide direction as to whether athletes should be advised to avoid future contact and collision sports because of the risk of adverse short-and long-term outcomes associated with future concussion. Over the years, several authors have offered recommendations about when athletes should be advised to retire from contact or collision sports, but most have focused on collegiate and professional athletes. 16,18,20,21,23,43,66,76,91,93 Although some authors suggest a more conservative approach should be applied to child and adolescent athletes, 16,23 indications for retirement from sports remain controversial and there are limited reports that discuss these issues in application to pediatric SRC patients. Because decisions regarding athlete retirement are complex and must be tailored to the individuals in the absence AbbreviAtioNs CTE = chronic traumatic encephalopathy; PCS = postconcussion syndrome; RTP = return to play; SCI = spinal cord injury; SCIWORA = SCI without radiographic abnormality; SRC = sports-related concussion; TBI = traumatic brain injury. The decision to advise an athlete to retire from sports following sports-related concussion (SRC) remains a persistent challenge for physicians. In the absence of strong empirical evidence to support recommendations, clinical decision making must be individualized and should involve a multidisciplinary team of experts in concussion and traumatic brain injury. Although previous authors have advocated for a more conservative approach to these issues in child and adolescent athletes, there are few reports outlining considerations for this process among this unique population. Here, the authors use multiple case illustrations to discuss 3 subgroups of clinical considerations for sports retirement among pediatric SRC patients including the ...

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“…Ford et al reported that the incidence of TON in the UK is similar in adults (1.01 per million) and children (0.99 cases per million), with the majority of cases occurring after relatively minor head injuries. Male preponderance, sports injuries, and falls were the most frequent causes [8]. Lee et al concluded that there was little evidence to suggest benefit of steroid treatment for isolated optic nerve injury, where visual loss is immediate.…”

Section: Discussionmentioning

confidence: 99%

Paediatric Orbital Fractures: The Importance of Regular Thorough Eye Assessment and Appropriate Referral

Kassam

Rahim

Mills

2013

Case Reports in Emergency Medicine

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The paediatric orbital fracture should always raise alarm bells to all clinicians working in an emergency department. A delay or failure in diagnosis and appropriate referral can result in rapidly developing and profound complications. We present a boy of childhood age who sustained trauma to his eye during a bicycle injury. Acceptance of the referral was based on no eye signs; however, on examination in our unit the eye had reduction in visual acuity, no pupillary reaction, and ophthalmoplegia. CT scan suggested bone impinging on the globe and the child was rushed to theatre for removal of the bony fragment. Postoperatively no improvement was noted and a diagnosis of traumatic optic neuropathy was made. An overview of factors complicating paediatric orbital injuries, their associated “red flags”, and appropriate referral are discussed in this short paper.

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A 2-year prospective surveillance of pediatric traumatic optic neuropathy in the United Kingdom

Cited by 30 publications

References 14 publications

Traumatic Optic Neuropathy

Traumatic Optic Neuropathy

Retirement-from-sport considerations following pediatric sports-related concussion: case illustrations and institutional approach

Paediatric Orbital Fractures: The Importance of Regular Thorough Eye Assessment and Appropriate Referral

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