Neuro-visual miscalculations in acute mTBI

Abstract

ObjectiveTo describe oculomotor abnormalities following acute mild traumatic brain injury (mTBI) as a possible target for Rehabilitation.BackgroundMore than 361,092 service members have sustained mTBI between 2000 and 2016.82.4 percent being mTBI. The vast majority improve within a few weeks. However, small percentages continue to have symptoms of Chronic TBI, including those with objective findings on oculomotor exam. The neuropathology of these finding are well documented and are possible targets of acute mTBI rehabilitation. This case series explores the typical finding of symptomatic patients after mTBI. Neuro-optometry is a subspecialty which evaluates the visual system for dysfunction following neurologic insult. Binocular dysfunction is prevalent following mTBI. Recent literature supports the hypothesis that the visual system can be utilized to evaluate the extent of brain injury. The NSUCO oculomotor test allows for quantification of saccadic and pursuit inaccuracies.MethodsThe case series reported here from the Intrepid Spirit Center (ISC), Fort Hood focuses on the treatment of acute mTBI patients referred by primary care providers or emergency departments. Three military service members with acute mTBI underwent a complete neurologic examination with a neurologist, including an oculomotor function assessment with a Neuro-optometrist utilizing the NSUCO oculomotor test (video attached).ResultsWe have video documentation demonstrates typical oculomotor dysfunction seen in acute mTBI patients, including poor initiation of saccades, inaccurate spatial planning and execution of saccades, and fixation losses on pursuits on binocular assessment.ConclusionOculomotor dysfunction is a verifiable, reproducible documentation of organic dysfunction in acute mTBI amenable to therapeutic approaches including neuro-optometric visual rehabilitation. Neuro-optometric vision rehab is a novel treatment modality for acute mTBI.