Vision Diagnoses Are Common After Concussion in Adolescents

Master, Christina L.; Scheiman, Mitchell; Gallaway, Michael; Goodman, Arlene; Robinson, Roni L.; Master, Stephen R.; Grady, Matthew F.

doi:10.1177/0009922815594367

Cited by 236 publications

(214 citation statements)

References 34 publications

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“…On multivariate analysis, the presence of VOD at initial consultation, a preinjury history of depression, and posttraumatic amnesia were found to be independent predictors of developing PCS following acute SRC. These results are in agreement with other studies that have demonstrated alterations in accommodation, convergence, and saccades following concussion 22,30,31 and 1 study that found that abnormal convergence was associated with prolonged recovery following pediatric concussion. 8 Previous studies have also suggested that a preinjury mood disorder 8,29 and posttraumatic amnesia 23 are independent predictors of longer recovery following SRC.…”

Section: Discussionsupporting

confidence: 93%

Clinical predictors of vestibulo-ocular dysfunction in pediatric sports-related concussion

Ellis

Cordingley²,

Vis³

et al. 2017

PED

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OBJECTIVE There were 2 objectives of this study. The first objective was to identify clinical variables associated with vestibulo-ocular dysfunction (VOD) detected at initial consultation among pediatric patients with acute sports-related concussion (SRC) and postconcussion syndrome (PCS). The second objective was to reexamine the prevalence of VOD in this clinical cohort and evaluate the effect of VOD on length of recovery and the development of PCS. METHODS A retrospective review was conducted for all patients with acute SRC and PCS who were evaluated at a pediatric multidisciplinary concussion program from September 2013 to May 2015. Acute SRS was defined as presenting < 30 days postinjury, and PCS was defined according to the International Classification of Diseases, 10th Revision criteria and included being symptomatic 30 days or longer postinjury. The initial assessment included clinical history and physical examination performed by 1 neurosurgeon. Patients were assessed for VOD, defined as the presence of more than 1 subjective vestibular and oculomotor complaint (dizziness, diplopia, blurred vision, etc.) and more than 1 objective physical examination finding (abnormal near point of convergence, smooth pursuits, saccades, or vestibulo-ocular reflex testing). Poisson regression analysis was used to identify factors that increased the risk of VOD at initial presentation and the development of PCS. RESULTS Three hundred ninety-nine children, including 306 patients with acute SRC and 93 with PCS, were included. Of these patients, 30.1% of those with acute SRC (65.0% male, mean age 13.9 years) and 43.0% of those with PCS (41.9% male, mean age 15.4 years) met the criteria for VOD at initial consultation. Independent predictors of VOD at initial consultation included female sex, preinjury history of depression, posttraumatic amnesia, and presence of dizziness, blurred vision, or difficulty focusing at the time of injury. Independent predictors of PCS among patients with acute SRC included the presence of VOD at initial consultation, preinjury history of depression, and posttraumatic amnesia at the time of injury. CONCLUSIONS This study identified important potential risk factors for the development of VOD following pediatric SRC. These results provide confirmatory evidence that VOD at initial consultation is associated with prolonged recovery and is an independent predictor for the development of PCS. Future studies examining clinical prediction rules in pediatric concussion should include VOD. Additional research is needed to elucidate the natural history of VOD following SRC and establish evidence-based indications for targeted vestibular rehabilitation.

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Section: Discussionsupporting

confidence: 93%

Clinical predictors of vestibulo-ocular dysfunction in pediatric sports-related concussion

Ellis

Cordingley²,

Vis³

et al. 2017

PED

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“…4 We have attempted to systematize the approach to PCS by using the response to exercise and physical assessment of the ANS, the cervical spine, and the visual and vestibular systems that are commonly affected by the injury that produces concussion. 4,22,23,73,75 In athletes with prolonged symptoms (.3-4 weeks), it is safe to assess exercise tolerance using the BCTT. 30,60,62,63 Athletes with a symptom-limited submaximal threshold (those who stop because of symptom exacerbation at a rating of perceived exertion ,18 and who do not achieve near-maximum predicted HR) are considered to have a persistently abnormal concussion physiology (which we believe is a dysautonomia that produces abnormally elevated exercise CBF).…”

Section: Management Of Persistent Postconcussive Symptomsmentioning

confidence: 99%

“…78 A physical sign-based approach to PCS reveals that the majority (approximately two-thirds) of patients do not have physiological concussion; rather, symptoms most often result from one of several PCDs, such as isolated or combined cervical, vestibular, or visual system injuries. 79 Identifying the source of symptoms allows the provider to prescribe specific active forms of therapy such as cervical physical therapy, 80 vision therapy, 23 or vestibular rehabilitation. 81 …”

Section: Management Of Persistent Postconcussive Symptomsmentioning

confidence: 99%

“…It is becoming evident that vision problems are common after concussion, that vision should be assessed acutely, 22 and that treatment is indicated for patients with persistent oculomotor problems. 23 The purpose of this paper is not to present a comprehensive overview of all of the physical and psychological consequences of concussion but to review the emerging evidence on the physiology of concussion, introduce the concept of exercise tolerance as a potential physiological biomarker of concussion and of concussion recovery, describe a physiological approach to the differential diagnosis of PCS, and discuss the management and physiological treatment of the atypical athlete with persistent symptoms after concussion.…”

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confidence: 99%

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A Physiological Approach to Prolonged Recovery From Sport-Related Concussion

Leddy¹,

Baker²,

Haider

et al. 2017

Journal of Athletic Training

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Management of the athlete with postconcussion syndrome (PCS) is challenging because of the nonspecificity of PCS symptoms. Ongoing symptoms reflect prolonged concussion pathophysiology or conditions such as migraine headaches, depression or anxiety, chronic pain, cervical injury, visual dysfunction, vestibular dysfunction, or some combination of these. In this paper, we focus on the physiological signs of concussion to help narrow the differential diagnosis of PCS in athletes. The physiological effects of exercise on concussion are especially important for athletes. Some athletes with PCS have exercise intolerance that may result from altered control of cerebral blood flow. Systematic evaluation of exercise tolerance combined with a physical examination of the neurologic, visual, cervical, and vestibular systems can in many cases identify one or more treatable postconcussion disorders.

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“…Several studies that have closely examined visual symptoms found a high rate after concussion, suggesting that subtle deficits may occur more commonly than is picked up on a general neurologic exam. Disorders of vergence [19], anticipatory tracking [20], accommodation and disconjugate eye movements [19] have been reported with rates of up to 90% in traumatic brain injury patients [21], with the rate of visual symptoms after concussion reported to be 69% in adolescents [22]. The rate of visual symptoms in young infants is not well described; however, the sustained gaze preference seen in our patient is more consistent with a localized deficit in gaze than to a disruption of more widespread circuitry controlling eye movements as described in these studies.…”

Section: Discussionmentioning

confidence: 99%

Transient Horizontal Gaze Palsy in a One-Month-Old Boy after a Fall

Bourne

Duhaime²

2015

Pediatr Neurosurg

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A 1-month-old boy was evaluated after a fall from a height of 3 feet and found to have right parietal skull fracture as well as right and left frontal traumatic hemorrhage. Ten days after the injury, he represented with a persistent left gaze preference. Further workup including MRI and EEG determined that this finding was most likely due to a small, focal, left-frontal eye field lesion. We review the horizontal gaze pathway and demonstrate that this is present at this very young age, and that a very focal and relatively minor injury can cause gaze disturbance.

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Vision Diagnoses Are Common After Concussion in Adolescents

Cited by 236 publications

References 34 publications

Clinical predictors of vestibulo-ocular dysfunction in pediatric sports-related concussion

Clinical predictors of vestibulo-ocular dysfunction in pediatric sports-related concussion

A Physiological Approach to Prolonged Recovery From Sport-Related Concussion

Transient Horizontal Gaze Palsy in a One-Month-Old Boy after a Fall

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