High Prevalence of Visual Midline Shift Syndrome in TBI: A Retrospective Study

Abstract

Background: Visual Midline Shift Syndrome (VMSS) is a common finding in patients who have suffered traumatic brain injury (TBI) and stroke. Proper identification of VMSS will allow for best patient management since VMSS has previously been shown to be treatable with Yoked Prism lenses. The purpose of this study was to determine the prevalence of VMSS in a group of patients with TBI compared to patients with no report of TBI. Methods: A single-center retrospective study of 60 patients (30 TBI and 30 non-TBI) was conducted by chart review to determine the prevalence and direction of VMSS in each group. The presence of VMSS was determined by Visual Midline Shift Testing where the patient was instructed to follow a moving Wolff Wand fixation target performed at 3 gazes horizontally from both directions to detect any right or left VMSS and then the procedure was repeated vertically to detect any anterior or posterior VMSS. Results: A much higher prevalence of VMSS was found in the TBI group (93%) compared to the non-TBI group (13%). This difference was found to be statistically significant by Chi-Square analysis (p-value of <0.0011). The directions of VMSS in the TBI group, in order of prevalence were right (82%), anterior (64%), posterior (11%), and left (7%). Chi-Square Goodness-of-Fit Test showed the prevalence of right VMSS is statistically different than left VMSS or no right/left VMSS. (p-value < 0.001) and anterior VMSS is statistically different than posterior VMSS or no anterior/posterior VMSS (p-value = 0.002). Conclusion: The prevalence of VMSS is extremely high in patients with TBI. Our study also found a much higher prevalence of right or anterior VMSS. Our data supported VMSS testing to be performed on all patients with a history of TBI.