| Identifier |
Traumatic_Brain_Injury_1080p_Lee |
| Title |
Traumatic Brain Injury |
| Creator |
Andrew G. Lee, MD; Justin Nguyen |
| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York; (JN) Baylor College of Medicine, Houston, Texas |
| Subject |
TBI; Trauma; Concussion; Convergence Insufficiency |
| Description |
Dr. Lee lectures medical students on the subject of traumatic brain injury. |
| Transcript |
So, I'm going to talk to you a little bit about traumatic brain injury as it applies to neurophtho. Obviously, the numbers on the traumatic brain injury is going up because not only are we seeing soldiers returning from Afghanistan and Iraq with explosive device injuries where they, they don't get killed or harmed they just get rattled. Football has been in the news a lot from chronic traumatic encephalopathy, but any concussion can cause this, and any kind of motor vehicle injury can cause it whether it's head injury. Leads to a lot of litigation, so you need to know a little bit about it. Of course, their eye exams are usually going to be normal. The most common thing that we see on the efferent side is convergence insufficiency exotropia. That's probably because the convergence is a neural network, and so getting the convergence to work requires not just one nerve, but kind of the function of a number of different areas of your brain. And because people are often a little bit uh fork to begin with, anything can break their fusion and they get convergence insufficiency exotropia. They often have dry eyes. It's not clear to me why that would occur. And they often have eye pain, and this eye pain is thought to be mediated by the similar pathogenesis for the other eye pain and photosensitivity syndromes like migraine. It's thought to be trigeminal thalamic pathway, and these patients may be photosensitive and might have the sunglass sign again. So, they're going to have normal eye exam and complain of dry eye, eye pain. And then we've got the processing problems that occur with the traumatic brain injury. Those processing problems require neurocognitive and neuropsychologic testing, and those can be processing in motion and space. One of the most problematic is when they have the visual variant vertigo. When motion in their environment triggers abnormal perception in the vestibular visual path way, and those people can't go to shopping in the grocery store because when they go down the aisle at the grocery store, they see this. Or when they're driving and or people are coming at them, they see this and so they have this subjective vertigo even though their ear function is normal and the vestibular function is normal and their MRI is normal. So those processing difficulties can be measured with formal testing. Usually, it's in visual spatial domains. Their complaints are going to be like lack of depth perception where things don't look right even if they're 20/20 and have a completely normal structural eye exam and a normal visual field. So, in addition to the normal things that we worry about in trauma in general on the afferent side like homonymous hemianopsia and cortical blindness and traumatic optic neuropathy and the efferent side-the usual cranial neuropathies-increased intracranial pressure related phenomenon, most of the traumatic brain injury people that are puzzling are the people who have normal imaging, normal eye exam, and what you should be looking for is convergence insufficiency, dry eyes, the eye pain, probably trigeminal thalamic mediated, photosensitivity, and visual processing abnormality. |
| Date |
2021-06 |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Andrew G. Lee Collection: https://novel.utah.edu/Lee/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6103306 |
| Setname |
ehsl_novel_lee |
| ID |
1701591 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6103306 |
