Ocular Motor Nerve Palsy After Traumatic Brain Injury: A Claims Database Study

Abstract

Supplemental Digital Content is Available in the Text.

Trochlear Nerve Palsy: A Systematic Review of Etiologies and Diagnostic Insights

“…Keane identified trauma in 113 of 215 TNP cases, representing the predominant etiology in that cohort [ 26 ]. In an extensive population-based analysis of 2.6 million patients with traumatic brain injury (TBI), Heo et al reported 1851 OMNPs, with TNP the most frequent subtype (37.7%) [ 37 ]. Similarly, Christoff observed trauma in 19 of 89 TNPs (21.3%) among 575 OMNPs [ 38 ].…”

Trochlear Nerve Palsy: A Systematic Review of Etiologies and Diagnostic Insights

“…Keane identified trauma in 113 of 215 TNP cases, representing the predominant etiology in that cohort [ 26 ]. In an extensive population-based analysis of 2.6 million patients with traumatic brain injury (TBI), Heo et al reported 1851 OMNPs, with TNP the most frequent subtype (37.7%) [ 37 ]. Similarly, Christoff observed trauma in 19 of 89 TNPs (21.3%) among 575 OMNPs [ 38 ].…”

Traumatic Brain Injury in Admitted Patients with Ocular Trauma

“… 9 , 10 , 12 , 13 , 14 , 15 , 16 , 17 However, few have evaluated the concurrence of ocular trauma and TBI and the circumstances of injury. 18 , 19 , 20 , 21 , 22 , 23 It is important for physicians to understand this association and identify at-risk populations, as they will frequently encounter patients with these comorbidities and may be a part of multidisciplinary teams managing the acute care and long-term rehabilitation.…”

“…Emergency department physicians evaluating patients in the context of acute major trauma may find it easier to identify the adducted eye of sixth nerve palsy than other ocular motor nerve palsies which might require more patient cooperation and a skilled examiner. Heo and Lambert 22 used claims data (2007-2016) and assessed rates of muscle transposition surgery and chemodenervation in third, fourth, and sixth nerve palsy in patients with TBI. They found that out of 2,606,600 patients with TBI, 1,851 patients (0.071%) had ocular motor nerve palsy and fourth nerve palsies were most frequent (37.7%).…”

“…For logistic regression analysis, continuous variables were categorized. ISS was categorized according to NTDB subgroups as minor (1)(2)(3)(4)(5)(6)(7)(8), moderate (9)(10)(11)(12)(13)(14)(15), severe (16)(17)(18)(19)(20)(21)(22)(23)(24), and very severe (>24). GCS, an index of degree of TBI, was categorized as mild (13)(14)(15), moderate (9)(10)(11)(12), and severe (≤8) brain injury.…”

“…11 While several reports have detailed the spectrum of ophthalmic manifestations of TBI, 9,10,12,13,14,15,16,17 few studies have studied simultaneous ocular trauma and TBI, with most reports detailing combatrelated blast injuries. 18,19,20,21,22,23 We used a national database to characterize epidemiologic patterns of non-combat injury in the United States. Identification of at-risk groups and 12,13,14,15,16…”

Trochlear Nerve Palsy: A Systematic Review of Etiologies and Diagnostic Insights

“…Keane identified trauma in 113 of 215 TNP cases, representing the predominant etiology in that cohort [ 26 ]. In an extensive population-based analysis of 2.6 million patients with traumatic brain injury (TBI), Heo et al reported 1851 OMNPs, with TNP the most frequent subtype (37.7%) [ 37 ]. Similarly, Christoff observed trauma in 19 of 89 TNPs (21.3%) among 575 OMNPs [ 38 ].…”

Traumatic Brain Injury in Admitted Patients with Ocular Trauma

“… 9 , 10 , 12 , 13 , 14 , 15 , 16 , 17 However, few have evaluated the concurrence of ocular trauma and TBI and the circumstances of injury. 18 , 19 , 20 , 21 , 22 , 23 It is important for physicians to understand this association and identify at-risk populations, as they will frequently encounter patients with these comorbidities and may be a part of multidisciplinary teams managing the acute care and long-term rehabilitation.…”

“…Emergency department physicians evaluating patients in the context of acute major trauma may find it easier to identify the adducted eye of sixth nerve palsy than other ocular motor nerve palsies which might require more patient cooperation and a skilled examiner. Heo and Lambert 22 used claims data (2007-2016) and assessed rates of muscle transposition surgery and chemodenervation in third, fourth, and sixth nerve palsy in patients with TBI. They found that out of 2,606,600 patients with TBI, 1,851 patients (0.071%) had ocular motor nerve palsy and fourth nerve palsies were most frequent (37.7%).…”

“…For logistic regression analysis, continuous variables were categorized. ISS was categorized according to NTDB subgroups as minor (1)(2)(3)(4)(5)(6)(7)(8), moderate (9)(10)(11)(12)(13)(14)(15), severe (16)(17)(18)(19)(20)(21)(22)(23)(24), and very severe (>24). GCS, an index of degree of TBI, was categorized as mild (13)(14)(15), moderate (9)(10)(11)(12), and severe (≤8) brain injury.…”

“…11 While several reports have detailed the spectrum of ophthalmic manifestations of TBI, 9,10,12,13,14,15,16,17 few studies have studied simultaneous ocular trauma and TBI, with most reports detailing combatrelated blast injuries. 18,19,20,21,22,23 We used a national database to characterize epidemiologic patterns of non-combat injury in the United States. Identification of at-risk groups and 12,13,14,15,16…”

Trochlear Nerve Palsy: A Systematic Review of Etiologies and Diagnostic Insights

“…Keane identified trauma in 113 of 215 TNP cases, representing the predominant etiology in that cohort [ 26 ]. In an extensive population-based analysis of 2.6 million patients with traumatic brain injury (TBI), Heo et al reported 1851 OMNPs, with TNP the most frequent subtype (37.7%) [ 37 ]. Similarly, Christoff observed trauma in 19 of 89 TNPs (21.3%) among 575 OMNPs [ 38 ].…”

Traumatic Brain Injury in Admitted Patients with Ocular Trauma

“… 9 , 10 , 12 , 13 , 14 , 15 , 16 , 17 However, few have evaluated the concurrence of ocular trauma and TBI and the circumstances of injury. 18 , 19 , 20 , 21 , 22 , 23 It is important for physicians to understand this association and identify at-risk populations, as they will frequently encounter patients with these comorbidities and may be a part of multidisciplinary teams managing the acute care and long-term rehabilitation.…”

“…Emergency department physicians evaluating patients in the context of acute major trauma may find it easier to identify the adducted eye of sixth nerve palsy than other ocular motor nerve palsies which might require more patient cooperation and a skilled examiner. Heo and Lambert 22 used claims data (2007-2016) and assessed rates of muscle transposition surgery and chemodenervation in third, fourth, and sixth nerve palsy in patients with TBI. They found that out of 2,606,600 patients with TBI, 1,851 patients (0.071%) had ocular motor nerve palsy and fourth nerve palsies were most frequent (37.7%).…”

“…For logistic regression analysis, continuous variables were categorized. ISS was categorized according to NTDB subgroups as minor (1)(2)(3)(4)(5)(6)(7)(8), moderate (9)(10)(11)(12)(13)(14)(15), severe (16)(17)(18)(19)(20)(21)(22)(23)(24), and very severe (>24). GCS, an index of degree of TBI, was categorized as mild (13)(14)(15), moderate (9)(10)(11)(12), and severe (≤8) brain injury.…”

“…11 While several reports have detailed the spectrum of ophthalmic manifestations of TBI, 9,10,12,13,14,15,16,17 few studies have studied simultaneous ocular trauma and TBI, with most reports detailing combatrelated blast injuries. 18,19,20,21,22,23 We used a national database to characterize epidemiologic patterns of non-combat injury in the United States. Identification of at-risk groups and 12,13,14,15,16…”