NUR 643 What would your assessment include if a client presents with sudden loss of vision of the right eye after a head collision during a volleyball game?
NUR 643 Week 2 DQs
- Description
Week 2 DQ 2 You are working the triage desk of the ED. A client presents with sudden loss of vision of the right eye after a head collision during a volleyball game. What would your assessment include? What could be initial problems and would they warrant emergent intervention?
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Visual loss following head trauma is common, and the diagnosis can be challenging for the neurologist called to perform an emergency room assessment. The approach to the patient with post-traumatic visual loss is complicated by a wide range of potential ocular and brain injuries with varying pathophysiology. In addition to direct injuries of the eye and orbit, traumatic optic neuropathies, carotid cavernous fistulas, and damage to the intracranial visual pathways are classic causes of visual loss after head trauma. This review provides an update on the diagnosis and management of these conditions.
Keywords: Carotid cavernous fistula, Traumatic brain injury, Traumatic optic neuropathy, Visual field defect, Visual loss
Visual loss is common after head trauma, but its diagnosis is often delayed. The clinical assessment is complicated by the fact that trauma patients may be unconscious and unable to provide a clinical history. Examination can be limited by lack of cooperation, concomitant physical injuries, and decreased level of consciousness. Alternatively, the traumatic event may seem minimal in relation to the visual loss, and the patient may be neurologically intact. Obvious evidence of trauma in the form of ocular or periorbital hemorrhage, laceration, or ecchymosis may be absent, and the injury causing the visual loss may be concealed. A wide range of lesions can result in visual loss, and the visual system can be affected at multiple levels (Table 1). A careful examination combined with appropriate neuroimaging should elucidate the nature of the visual loss and guide initiation of optimal management.1-6 The aim of this review is to help neurologists develop a rational approach to evaluating the patient with post-traumatic visual loss.
Table 1