title: Severe cranial neuropathies caused by falls from heights in children.
abstract: OBJECTIVE
  Falls from heights are the most common traumatic event associated with emergency department visits in children. This study investigated the incidence and clinical course of cranial neuropathies caused by falls from heights in children.
  
  
  METHODS
  The computerized records of a tertiary pediatric medical center were searched for all patients admitted to the emergency department in 2004-2014 with a head injury caused by falling from a height. Those with cranial neuropathies involving optic and eye-motility disturbances were identified, and their clinical, imaging, and outcome data were evaluated.
  
  
  RESULTS
  Of the estimated 61,968 patients who presented to the emergency department during the study period because of a fall, 18,758 (30.3 %) had head trauma. Only 12 (seven boys, five girls, average age 6.7 years) had a visual disturbance. Eight were diagnosed with traumatic optic neuropathy, one after a 6-month delay, including two with accompanying cranial nerve (CN) III injuries. Five patients had anisocoria or an abnormal pupillary response to light at presentation, one patient had CN VI paralysis and temporary vision loss, and one patient had an isolated CN III injury diagnosed on follow-up. Visual improvement varied among the patients.
  
  
  CONCLUSIONS
  Cranial neuropathies due to falls from heights are rare in children and are associated with high visual morbidity. Vision or ocular motility impairment, especially monocular vision loss, may be missed during acute intake to the emergency department, and a high index of suspicion is needed. Assessment of the pupillary response to light is essential.
authors.affiliation: Department of Ophthalmology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, lsrael.|Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Zahavi
authors.affiliation: Department of Radiology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.
authors.forename: J
authors.initials: J
authors.lastname: Luckman
authors.affiliation: Department of Ophthalmology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, lsrael.
authors.forename: I
authors.initials: I
authors.lastname: Yassur
authors.affiliation: Pediatric Neurosurgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.|Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: S
authors.initials: S
authors.lastname: Michowiz
authors.affiliation: Department of Pediatric Ophthalmology, Schneider Children's Medical Center of Israel, Petach Tikva, 49202, Israel. ncohen1@gmail.com.|Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. ncohen1@gmail.com.|The Krieger Eye Research Laboratory, Felsenstein Medical Research Center, Petach Tikva, Israel. ncohen1@gmail.com.
authors.forename: N
authors.initials: N
authors.lastname: Goldenberg-Cohen
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007557:Israel / Q000453:epidemiology; D008297:Male; D015835:Ocular Motility Disorders / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D015840:Oculomotor Nerve Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D009901:Optic Nerve Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D014057:Tomography, X-Ray Computed
keywords: Cranial neuropathies; Fall; Pediatric head trauma; Trauma; Traumatic optic neuropathy