title: Traumatic Optic Neuropathy: A Potentially Unrecognized Diagnosis after Sports-Related Concussion.
abstract: Traumatic optic neuropathy is a rare cause of visual disturbance after head injury that can be difficult to distinguish from coexisting vestibulo-ocular dysfunction because of the overlap in presenting symptoms in patients with these conditions. We present a case report of a 13-year-old girl who sustained a head injury during a ringette game leading to blurred vision and diplopia persisting 5 months after injury. Clinical history and physical examination findings were consistent with a traumatic optic neuropathy, convergence insufficiency, and postconcussion syndrome. Neuroimaging was normal. The patient was managed using a multidisciplinary approach. At 6 months of follow-up, neuro-ophthalmological examination demonstrated evidence of permanent partial optic nerve injury, and formal neuropsychological testing fell primarily within normal limits. The patient was advised to retire from collision sports. The authors discuss the value of a comprehensive multidisciplinary approach to the evaluation and management of concussion patients presenting with persistent visual symptoms.
authors.affiliation: 1Department of Surgery, University of Manitoba, Winnipeg, Manitoba, CANADA; 2Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, CANADA; 3Department of Diagnostic Imaging, University of Manitoba, Winnipeg, Manitoba, CANADA; 4Section of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, CANADA; 5Pan Am Concussion Program, Pan Am Clinic, Winnipeg Manitoba, CANADA; 6Children's Hospital Research Institute of Manitoba, Canada North Concussion Network, Winnipeg, Manitoba, CANADA; 7Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, CANADA; and 8Department of Neurology and Neuro-ophthalmology, University of Manitoba, Winnipeg, Manitoba, CANADA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Ellis
authors.forename: Lesley
authors.initials: L
authors.lastname: Ritchie
authors.forename: Dean
authors.initials: D
authors.lastname: Cordingley
authors.forename: Marco
authors.initials: M
authors.lastname: Essig
authors.forename: Behzad
authors.initials: B
authors.lastname: Mansouri
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000175:diagnosis / Q000209:etiology; D001924:Brain Concussion / Q000150:complications* / Q000175:diagnosis*; D005260:Female; D006688:Hockey / Q000293:injuries*; D006801:Humans; D020221:Optic Nerve Injuries / Q000175:diagnosis* / Q000209:etiology*