Traumatic Optic Neuropathy

Ellis, Michael J.; Ritchie, Lesley; Cordingley, Dean M.; Essig, Marco; Mansouri, Behzad

doi:10.1249/jsr.0000000000000223

Cited by 15 publications

(5 citation statements)

References 21 publications

(29 reference statements)

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“…In a subset of patients with traumatic vision loss after head trauma, the cause is injury to the optic nerve and its projections [ 34 ]. Damage specifically to the optic nerve is termed traumatic optic neuropathy (TON), and has been reported with all severities of TBI [ 35 ], including concussion [ 36 ]. TON can occur either by direct or indirect mechanisms, where direct injury is caused by a foreign body or broken bone directly damaging the optic nerve [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Optic tract injury after closed head traumatic brain injury in mice: A model of indirect traumatic optic neuropathy

et al. 2018

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Adult male C57BL/6J mice have previously been reported to have motor and memory deficits after experimental closed head traumatic brain injury (TBI), without associated gross pathologic damage or neuroimaging changes detectable by magnetic resonance imaging or diffusion tensor imaging protocols. The presence of neurologic deficits, however, suggests neural damage or dysfunction in these animals. Accordingly, we undertook a histologic analysis of mice after TBI. Gross pathology and histologic analysis using Nissl stain and NeuN immunohistochemistry demonstrated no obvious tissue damage or neuron loss. However, Luxol Fast Blue stain revealed myelin injury in the optic tract, while Fluoro Jade B and silver degeneration staining revealed evidence of axonal neurodegeneration in the optic tract as well as the lateral geniculate nucleus of the thalamus and superior colliculus (detectable at 7 days, but not 24 hours, after injury). Fluoro Jade B staining was not detectable in other white matter tracts, brain regions or in cell somata. In addition, there was increased GFAP staining in these optic tract, lateral geniculate, and superior colliculus 7 days post-injury, and morphologic changes in optic tract microglia that were detectable 24 hours after injury but were more prominent 7 days post-injury. Interestingly, there were no findings of degeneration or gliosis in the suprachiasmatic nucleus, which is also heavily innervated by the optic tract. Using micro-computed tomography imaging, we also found that the optic canal appears to decrease in diameter with a dorsal-ventral load on the skull, which suggests that the optic canal may be the site of injury. These results suggest that there is axonal degeneration in the optic tract and a subset of directly innervated areas, with associated neuroinflammation and astrocytosis, which develop within 7 days of injury, and also suggest that this weight drop injury may be a model for studying indirect traumatic optic neuropathy.

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Section: Discussionmentioning

confidence: 99%

Optic tract injury after closed head traumatic brain injury in mice: A model of indirect traumatic optic neuropathy

et al. 2018

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“…Symptoms commonly reported by athletes with PCS include headaches, dizziness, sensitivity to light and sound, difficulty focusing or concentrating, sleep disturbance, and fatigue. Because some athletes, in particular children, may not have the vocabulary to express subtle aspects of their symptoms, it is important that physicians ask specifically about fixed or transient neurological deficits such as monocular blurred vision or transient weakness or numbness that can point to focal injury to central and peripheral nervous system structures (63–65). …”

Section: Initial Assessmentmentioning

confidence: 99%

“…All patients should undergo a cervical spine examination that includes range of motion, palpation, and provocative ligament and cervical dizziness testing. Patients that report monocular visual symptoms should undergo careful testing of pupillary function, visual acuity, visual fields, color vision, as well as fundoscopy to rule out optic nerve or retinal pathology (65). Those that report a history of intermittent vertigo should undergo the Dix-Hallpike maneuver to test for benign paroxysmal positional vertigo (BPPV).…”

Section: Initial Assessmentmentioning

confidence: 99%

Multi-Disciplinary Management of Athletes with Post-Concussion Syndrome: An Evolving Pathophysiological Approach

2016

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Historically, patients with sports-related concussion (SRC) have been managed in a uniform fashion consisting mostly of prescribed physical and cognitive rest with the expectation that all symptoms will spontaneously resolve with time. Although this approach will result in successful return to school and sports activities in the majority of athletes, an important proportion will develop persistent concussion symptoms characteristic of post-concussion syndrome (PCS). Recent advances in exercise science, neuroimaging, and clinical research suggest that the clinical manifestations of PCS are mediated by unique pathophysiological processes that can be identified by features of the clinical history and physical examination as well as the use of graded aerobic treadmill testing. Athletes who develop PCS represent a unique population whose care must be individualized and must incorporate a rehabilitative strategy that promotes enhanced recovery of concussion-related symptoms while preventing physical deconditioning. In this review, we present our evolving evidence-based approach to evaluation and management of athletes with PCS that aims to identify the pathophysiological mechanisms mediating persistent concussion symptoms and guides the initiation of individually tailored rehabilitation programs that target these processes. In addition, we outline the important qualified roles that multi-disciplinary healthcare professionals can play in the management of this patient population, and discuss where future research efforts must be focused to further evaluate this evolving pathophysiological approach.

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“…Physical examination commonly reveals a combination of findings including objective impairments in convergence, accommodation, smooth pursuits, saccades, balance, gait, and vestibulo-ocular reflex functioning (43, 44). In more rare cases, athletes with sport-related concussion can present with cranial neuropathies (45, 46) or clinical evidence of peripheral vestibular disorders, such as benign paroxysmal positional vertigo (BPPV) or unilateral vestibular hypofunction (47–49). Studies suggest that acute concussion patients who present with clinical evidence of vestibulo-ocular dysfunction at initial assessment report a higher burden of concussion symptoms and take longer to recover compared to those without these features (50, 51).…”

Section: The Physiology and Clinical Manifestations Of Acute Concussionmentioning

confidence: 99%

A Physiological Approach to Assessment and Rehabilitation of Acute Concussion in Collegiate and Professional Athletes

et al. 2018

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Sport-related concussion is an important condition that can affect collegiate and professional athletes. Expert consensus guidelines currently suggest that all athletes who sustain acute concussion be managed with a conservative approach consisting of relative rest and gradual resumption of school and sport activities with active intervention reserved for those with persistent post-concussion symptoms lasting >10–14 days for adults. Unfortunately, these recommendations place little emphasis on the rapid physical deconditioning that occurs in athletes within days of exercise cessation or the pathophysiological processes responsible for acute concussion symptoms that can be successfully targeted by evidence-based rehabilitation strategies. Based on our evolving approach to patients with persistent post-concussion symptoms, we now present an updated physiological approach to the initial medical assessment, rehabilitation, and multi-disciplinary management of collegiate and professional athletes with acute concussion. Utilizing the results of a careful clinical history, comprehensive physical examination and graded aerobic exercise testing, we outline how team physicians, and athletic training staff can partner with multi-disciplinary experts in traumatic brain injury to develop individually tailored rehabilitation programs that target the main physiological causes of acute concussion symptoms (autonomic nervous system dysfunction/exercise intolerance, vestibulo-ocular dysfunction, and cervical spine dysfunction) while maintaining the athlete's physical fitness during the recovery period. Considerations for multi-disciplinary medical clearance of collegiate and professional athletes as well as the application of this approach to non-elite athletes are also discussed.

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Traumatic Optic Neuropathy

Cited by 15 publications

References 21 publications

Optic tract injury after closed head traumatic brain injury in mice: A model of indirect traumatic optic neuropathy

Optic tract injury after closed head traumatic brain injury in mice: A model of indirect traumatic optic neuropathy

Multi-Disciplinary Management of Athletes with Post-Concussion Syndrome: An Evolving Pathophysiological Approach

A Physiological Approach to Assessment and Rehabilitation of Acute Concussion in Collegiate and Professional Athletes

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