PDF(Pubmed)
Abstract：
OBJECTIVE: Function and anatomy of the visual system were evaluated in children with abusive head trauma (AHT). The relationships between retinal hemorrhages at presentation were examined with outcome measures.
METHODS: Retrospective review of data in children with AHT for 1) visual acuity at last follow-up, 2) visual evoked potentials (VEP) after recovery, 3) diffusion metrics of white matter tracts and grey matter within the occipital lobe on diffusion tensor imaging (DTI), and 4) patterns of retinal hemorrhages at presentation. Visual acuity was converted into logarithm of minimum angle of resolution (logMAR) after correction for age. VEPs were also scored by objective signal-to-noise ratio (SNR).
RESULTS: Of 202 AHT victims reviewed, 45 met inclusion criteria. Median logMAR was reduced to 0.8 (approximately 20/125 Snellen equivalent), with 27% having no measurable vision. Thirty-two percent of subjects had no detectable VEP signal. VEPs were significantly reduced in subjects initially presenting with traumatic retinoschisis or hemorrhages involving the macula (p < 0.01). DTI tract volumes were decreased in AHT subjects compared to controls (p < 0.001). DTI metrics were most affected in AHT victims showing macular abnormalities on follow-up ocular examination. However, DTI metrics were not correlated with visual acuity or VEPS. There was large inter-subject variability within each grouping.
CONCLUSIONS: Mechanisms causing traumatic retinoschisis, or traumatic abnormalities of the macula, are associated with significant long-term visual pathway dysfunction. AHT associated abnormalities of the macula, and visual cortical pathways were more fully captured by VEPs than visual acuity or DTI metrics.
METHODS: Retrospective review of data in children with AHT for 1) visual acuity at last follow-up, 2) visual evoked potentials (VEP) after recovery, 3) diffusion metrics of white matter tracts and grey matter within the occipital lobe on diffusion tensor imaging (DTI), and 4) patterns of retinal hemorrhages at presentation. Visual acuity was converted into logarithm of minimum angle of resolution (logMAR) after correction for age. VEPs were also scored by objective signal-to-noise ratio (SNR).
RESULTS: Of 202 AHT victims reviewed, 45 met inclusion criteria. Median logMAR was reduced to 0.8 (approximately 20/125 Snellen equivalent), with 27% having no measurable vision. Thirty-two percent of subjects had no detectable VEP signal. VEPs were significantly reduced in subjects initially presenting with traumatic retinoschisis or hemorrhages involving the macula (p < 0.01). DTI tract volumes were decreased in AHT subjects compared to controls (p < 0.001). DTI metrics were most affected in AHT victims showing macular abnormalities on follow-up ocular examination. However, DTI metrics were not correlated with visual acuity or VEPS. There was large inter-subject variability within each grouping.
CONCLUSIONS: Mechanisms causing traumatic retinoschisis, or traumatic abnormalities of the macula, are associated with significant long-term visual pathway dysfunction. AHT associated abnormalities of the macula, and visual cortical pathways were more fully captured by VEPs than visual acuity or DTI metrics.
摘要：
目的：评估虐待性颅脑外伤（AHT）儿童的视觉系统功能和解剖结构。通过预后措施检查了出现时视网膜出血之间的关系。
方法：在最后一次随访时，回顾性回顾AHT儿童的1）视力数据，2）恢复后的视觉诱发电位（VEP），3）扩散张量成像（DTI）上枕叶内白质束和灰质的扩散指标，和4）出现时视网膜出血的模式。校正年龄后，将视力转换为最小分辨率角（logMAR）的对数。还通过客观信噪比(SNR)对VEP进行评分。
结果：对202名AHT受害者进行了审查，45符合纳入标准。中位数logMAR降低到0.8（大约相当于20/125Snellen），27%的人没有可测量的视力。32%的受试者没有检测到的VEP信号。最初出现创伤性视网膜裂孔或黄斑出血的受试者的VEP显著降低(p<0.01)。与对照相比,AHT受试者的DTI道体积减少(p<0.001)。DTI指标在AHT患者中受到的影响最大，在随访眼部检查中显示黄斑异常。然而,DTI指标与视力或VEPS无关。每个分组内的受试者间差异很大。
结论：引起外伤性视网膜劈裂的机制，或者黄斑的创伤性异常，与显著的长期视觉通路功能障碍有关。AHT相关的黄斑异常，与视力或DTI指标相比，VEP更充分地捕获了视觉皮层通路。
方法：在最后一次随访时，回顾性回顾AHT儿童的1）视力数据，2）恢复后的视觉诱发电位（VEP），3）扩散张量成像（DTI）上枕叶内白质束和灰质的扩散指标，和4）出现时视网膜出血的模式。校正年龄后，将视力转换为最小分辨率角（logMAR）的对数。还通过客观信噪比(SNR)对VEP进行评分。
结果：对202名AHT受害者进行了审查，45符合纳入标准。中位数logMAR降低到0.8（大约相当于20/125Snellen），27%的人没有可测量的视力。32%的受试者没有检测到的VEP信号。最初出现创伤性视网膜裂孔或黄斑出血的受试者的VEP显著降低(p<0.01)。与对照相比,AHT受试者的DTI道体积减少(p<0.001)。DTI指标在AHT患者中受到的影响最大，在随访眼部检查中显示黄斑异常。然而,DTI指标与视力或VEPS无关。每个分组内的受试者间差异很大。
结论：引起外伤性视网膜劈裂的机制，或者黄斑的创伤性异常，与显著的长期视觉通路功能障碍有关。AHT相关的黄斑异常，与视力或DTI指标相比，VEP更充分地捕获了视觉皮层通路。
