Management of traumatic optic neuropathy with coexistent spinal cord injury: a case report.
Traumatic optic neuropathy (TON) causes blindness of varied severity and occurs infrequently as a complication of closed head injury. A case is presented of TON that occurred in a patient who suffered complete T4 paraplegia from a motorcycle accident but in whom no severe head injury took place. In this case, high-dose intravenous methylprednisolone was begun for the spinal cord injury and repeated 24 hours later for the TON. Vision improved from near total blindness to 20/400 in the left eye (OS) and 20/130 in the right eye (OD). Two weeks later, however, the patient's vision suddenly worsened. Magnetic resonance imaging (MRI) using fat suppression confirmed a lesion along the optic nerve consistent with TON. A third course of methylprednisolone again led to improved vision. The steroids were then tapered orally over 2 weeks and the patient had no further relapses. Moderate to severely impaired vision of 20/ 400 OS and 20/130 OD continues to interfere with the patient's function and spinal cord rehabilitation program. It was concluded that a steroid taper was important in maintaining initial visual gains in this case. Awareness of TON and careful attention to the patient's clinical course can minimize deficit and maximize functional outcomes.
Sherman
A L
AL
Department of Rehabilitation Medicine, University of Washington, Seattle 98195, USA.
Cardenas
D D
DD
Swedberg
S
S
D000203:Activities of Daily Living; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D016903:Drug Monitoring; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D018917:Optic Neuropathy, Ischemic / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D013119:Spinal Cord Injuries / Q000150:complications* / Q000534:rehabilitation; D014792:Visual Acuity
D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone