Neuro-ophthalmic manifestations of head trauma

Objective To describe the neuro-ophthalmic findings in a group of patients with head trauma. Materials and Methods A retrospective chart review of all patients given a diagnosis code of head trauma in the neuro-ophthalmology unit at Emory University between 1991 and 1999. Results A total of 326 consecutive patients were reviewed (203 [63%] men and 123 [37.0%] women). Age ranged from 2 to 86 years, with a mean of 30 years. Motor vehicle accident was the most common cause of head trauma, occurring in 195 (59.8%) patients. An abnormal neuro-ophthalmic examination was noted in 185 of 326 patients (56.7%). Loss of consciousness was not associated with any outcome, but the presence of a neuroimaging abnormality, particularly intracranial hemorrhage, was significantly associated with specific neuro-ophthalmic deficits. Conclusions Head trauma causes a number of neuro-ophthalmic manifestations. The afferent and efferent pathways are vulnerable to traumatic injury, although the efferent system is more commonly affected. Loss of consciousness may not be a reliable predictor of specific neuro-ophthalmic outcomes, but neuroimaging abnormalities may.