Visual disturbances following MTBI in school-aged children

Abstract

Introduction: As far as the statistic outline that the rate of mTBI among children is all the time in progress rating double as speaking about school aged children, we find difficult evaluating this group of patients. That is why visual disturbances that may outcome of a brain trauma in a child will have a define role in its future development as an adult. Approach comes while we speak of children versus adults, requesting an adequate evaluation for visual post traumatic disturbances that may pass undetermined. Aim of the study is to determine and classify visual disturbances that appear after head trauma in children in order to assess a personalized, but also an objective approach to them. Materials and methods: The study was a case control research based on 48 patients hospitalized at the neurosurgery department suffering from a traumatic brain injury (TBI) and 48 patients with visual disturbances but with no brain injury in the past five years. The patients have undergone a full ophthalmological evaluation by using all of the standard and auxiliary investigations required. Evaluation algorithm has been selected individually since the patients were hospitalized at different age and general status. Results: Thus in the mTBI group the visual acuity for the right eye was of 0.09—0.5 in 83.7% (40 patients), in 16.3% (8 patients) – right eye 0.6—0.8, comparing to the control group, were 62% patients had the visual acuity ranged almost in 1.0, just 14% (7 patients) was ranged 0.09-0.5 and in 24% (12 patients) - la 0.6—0.8. The visual acuity for the left eye in the research group was of 0.09—0,5 in 89.8% (43 patients), in 10.2% (5 patients) –for the left eye was 0.6—0.8, comparing to the control group, were 66% patients had the visual acuity ranged almost in 1.0, just 24% (12 patients) was ranged 0.09-0,5 and in 14% (5 patients) – 0,6—0.8. Autorefraction data usually will reveal a slight hyperopia with a possible astigmatic component ranged between 1D to 3D, and in a 4.1%–8.2% cases a slight myopia referring to the spherical compound and 18.4%–32.7% astigmatic compound, also ranged between 1D and 3D. There have been also determined changes in visual field examination in the acute stage after trauma, patients presenting fixation loss in almost 89.8% establishing decreased sensitivity with altered peripheral scattered defects. Recording to the contrast sensitivity test we may also outline a clear disturbance for color perception being present in 94% cases after TBI. We may also outline that 45 children presented convergence insufficiency with an average near-point of convergence (NPC) ranged between 7-9 mm. Conclusion: The research noted once again that children present a full spectrum of vision alteration being a process established fast but with clear peculiarities for a full recovery. Due to some distinguished aspects in cerebral blood flow regulation, the pediatric age group is subject to the development of intracranial hypertension (ICH), the cause of the development of which is the expansion of the brain. This reveals the cause for the acute onset of visual disturbances after head injury in children. Also it has been revealed that most of the standard ophthalmologic investigations should be indicated not in the acute stage since the values may be increased due to a transient picture of visual disturbances without a need in treatment but only with concern of future evaluation.