The frequency of occurrence, types, and characteristics of visual field defects in acquired brain injury: a retrospective analysis.
ABSTRACT The purpose of this retrospective study was to determine the frequency of occurrence of visual field defects in a sample of visually symptomatic, ambulatory outpatients who have acquired brain injury (ABI), either traumatic brain injury (TBI) or cerebral vascular accident (CVA).
The medical records of 220 individuals with TBI (n=160) or CVA (n=60) were reviewed retrospectively. This was determined by a computer-based query spanning the years 2000 through 2003. The individuals' records were reviewed to determine the frequency of targeted visual field defects that were classified as scattered, restricted, homonymous, nonhomonymous, and visual neglect. The altitudinal and lateral characteristics of these defects were also determined.
In the total ABI sample of 220, some 102 (46.36%) individuals had 1 of the targeted defects diagnosed. These defects were present in 62 (38.75%) of the TBI subgroup and in 40 (66.67%) of the CVA subgroup. The most frequent defects in the TBI group were scattered (58.06%) followed by homonymous (22.58%). In the CVA group, the most numerous were homonymous (47.5%), with scattered and nonhomonymous accounting for 20% each.
The uniqueness of the current study is that it reports the frequency of occurrence of specified visual field defects in the total ABI sample and in the TBI and CVA subgroups. This enabled comparisons with other studies that generally have reported on just 1 of these groupings. The current results are in accord with most of the other studies that are reviewed. The findings of this study should alert the reader to the high frequency of occurrence of visual field defects in the ABI population, and make the reader aware of the adverse effects they can have on quality of life and rehabilitation.
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ABSTRACT: There are known limitations of conventional computed tomography and magnetic resonance imaging in detecting neural injury in patients with mild traumatic brain injury (TBI). Diffusion tensor imaging (DTI) provides a method to further assess cerebral injury in this patient population. We report 2 patients with mild TBI who showed injury of the optic radiation (OR) as demonstrated by DTI. Two patients who complained of visual field loss after mild TBI and 9 age-matched normal control subjects were recruited for this study. Peripheral field defects were detected with automated perimetry in both patients. Regarding the configuration of OR, the total volume of OR was decreased in the right OR of both patients compared with controls; in contrast, the left ORs were divided into 2 parts in both patients. The voxel numbers of both ORs in both patients were more than 2 standard deviations lower than that of normal control subjects. The apparent diffusion coefficient value of the right OR in patient 2 was more than 2 standard deviations higher than that of normal controls. We demonstrated injury of the OR using DTI in 2 patients who showed visual field defects after mild TBI.Journal of neuro-ophthalmology: the official journal of the North American Neuro-Ophthalmology Society 04/2015; DOI:10.1097/WNO.0000000000000249 · 1.81 Impact Factor
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ABSTRACT: The purpose of this paper is to describe the response of a Department of Veterans Affairs medical center's development of a rehabilitation program for patients with hemianopsia. Hemianopsia affects significant numbers of troops returning from Afghanistan and Iraq and their neurological vision loss presented unique challenges in developing an appropriate and effective rehabilitation program. A literature review indicated that existing therapies lacked supporting sci-entific evidence and that traumatic brain injury (TBI)-related vision loss affects large numbers of civilians. The increasing number of patients with TBI-related vision loss necessitated the develop-ment of an innovative program which combined elements of therapies that the literature suggested were most promising. In this paper we briefly review the literature, describe the rehabilitation program developed, and present case studies of two patients who incurred vision loss as a result of a motor vehicle accident and a gunshot wound. The intent of the article is to begin the docu-mentation of our ongoing, evidence-based neurological vision loss rehabilitation program. We also encourage others who do not currently do so to assess the need for implementing vision rehabilitation programs for patients with TBI-related vision loss.
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ABSTRACT: Traumatic brain injury (TBI) is the leading injury coming out of the past decades' two major military conflicts, with mild TBI (mTBI) being the most commonly diagnosed form. The aim of this study was to assess the frequency and types of visual field (VF) defects seen at different testing stages following nonblast and blast-induced mTBI. A comprehensive retrospective review was performed on 500 electronic health records for military personnel sustaining an mTBI during deployment, of which 166 patients were tested with both confrontation VF and 30-2 Humphrey Matrix Frequency Doubling Technology (FDT) perimetry. Scatter defects (48%) were the most predominantly found deficits in both blast and nonblast mTBI injury mechanisms and over postinjury test time frames. Confrontation VF was shown to be a poor qualitative predictor of VF defect. A profound decrease in VF sensitivity was noted in comparison to previously reported FDT normative data. Finally, a significant trend of decreasing VF defects was seen over time, indicating the potential usage of FDT as a visual biomarker for monitoring mTBI recovery. The findings of this study highlight the importance of performing threshold perimeter testing in those who have suffered an mTBI or concussion-like event. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.Military medicine 02/2015; 180(2):178-85. DOI:10.7205/MILMED-D-14-00230 · 0.77 Impact Factor