目的:研究闭合性颅脑损伤患者的各种眼部表现,为了找到与神经受累程度的任何关联,并分析必要干预后的治疗结果。
方法:印度东部三级转诊医院。
方法:前瞻性观察性研究。
方法:招募了2017年10月至2019年9月在我们门诊部就诊并从神经外科转诊进行眼科评估的闭合性头部损伤患者。所有符合纳入标准的患者均由经验丰富的眼科医生进行检查。神经外科小组采用格拉斯哥昏迷量表(GCS)对神经系统受累进行分级。记录眼部发现,并要求进行必要的成像。对有神经系统检查结果的患者进行了适当的神经外科咨询。所有眼外伤均按照机构方案进行管理。描述性统计用于分析,p<0.05为统计学上显著的。
结果:共207例患者(414只眼)纳入研究。平均年龄为33.82岁,男性患者患病率(82.12%)。颅脑损伤最常见的原因是RTA(57.01%),其次是攻击(11.59%)。大多数患者(53.14%)被归类为中度,46.37%的患者为轻度,根据GCS评分,0.48%患有严重的神经系统受累。在70.04%的患者中观察到孤立的眼部表现,而29.95%的患者同时具有神经系统和眼科特征。观察到38.6%的眼附件受累,86%的眼前节受累,33.3%的神经眼科表现,38.6%的患者受累后节段。48.8%的患者在适当的时间内眼部体征得到缓解,完全解决28%,而6.28%的患者没有改善。51.69%的患者最终获得>6/18的最佳矫正视力。GCS评分与一般眼部发现(p=0.02)以及相对传入瞳孔缺损(p=0.003)之间的相关性具有统计学意义。年龄>50岁与神经眼科特征之间的关联未发现有统计学意义(p=0.56)。
结论:演示时视力不佳,视神经管骨折,眼眶壁多处骨折的存在,开始静脉注射皮质类固醇48小时内视力无改善,是这项研究中视力预后不良的指标。GCS,神经缺陷,和眼部体征对结果的预测有重要贡献。及时治疗和转诊可以很好地解决症状和体征。
OBJECTIVE: To
study the various ocular findings in patients with closed head injuries, to find any association with the degree of neurological involvement, and to analyze the treatment outcome after the necessary intervention.
METHODS: Tertiary referral hospital in Eastern India.
METHODS: Prospective observational
study.
METHODS: Patients with closed head injuries attending our Outpatient department as well as referred from the Neurosurgery department for ophthalmic evaluation between October 2017 and September 2019 were recruited for the
study. All patients meeting the inclusion criteria were examined by an experienced ophthalmologist. The Glasgow coma scale (GCS) was applied to grade the neurological involvement by the neurosurgery team. Ocular findings were recorded and necessary imaging was requested. Appropriate neurosurgery consultations were done in patients with neurological findings. All ocular injuries were managed as per institutional protocol. Descriptive statistics were used for analysis with p< 0.05 taken as statistically significant.
RESULTS: A total of 207 patients (414 eyes) were included in the
study. The mean age was 33.82 years, with the prevalence of male patients (82.12%). The most common cause of head injury was RTA (57.01%) followed by assault (11.59%). The majority of patients (53.14%) were classified as having moderate, 46.37% patients with mild, and 0.48% with severe neurological involvement as per GCS scoring. Isolated ocular findings were seen in 70.04% of patients while 29.95% of patients had both neurological and ophthalmic features. Ocular adnexal involvement was observed in 38.6%, anterior segment involvement in 86%, neuro-ophthalmic manifestations in 33.3%, and posterior segment involvement in 38.6% of patients. Ocular signs were resolved over due course of time in 48.8% of patients, completely resolved in 28%, while there was no improvement in 6.28% of patients. The final best-corrected visual acuity of >6/18 was achieved in 51.69% of patients. Statistical significance was observed in the correlation between the GCS scoring and general ocular findings (p= 0.02) as well as a relative afferent pupillary defect (p=0.003). The association between age > 50 years and neuro-ophthalmic features was not found to be statistically significant (p=0.56).
CONCLUSIONS: Poor visual acuity at presentation, optic canal fractures, the presence of multiple fractures of orbital walls, no improvement in vision within 48 hours of starting intravenous corticosteroids, were indicators of a poor visual prognosis in this
study. The GCS, neuro-deficit, and ocular signs contribute significantly to the prediction of outcomes. Prompt treatment and referral can lead to a good resolution of symptoms and signs.