严重头部创伤后30年的持续性视力问题

作     者：Muri R.M. Klimmeck E. Imesch P. 韩静 

作者机构：Abteilung fr Neuropsychologisc he Rehabilitation Inselspital 3010 Bern Switzerland 

出 版 物：《世界核心医学期刊文摘（眼科学分册）》 (Digest of the World Core Medical Journals:Ophthalmology)

年 卷 期：2005年第1卷第10期

页      面：10-10页

学科分类：1002[医学-临床医学] 100212[医学-眼科学] 10[医学] 

主　　题：持续性 眼球震颤 中央眼 视觉系统 脑干挫伤 运动障碍 神经麻痹 矫正器 屈光矫正 上隐斜 

摘      要：Introduction. Visual disturbances are common after severe head trauma. Some au thors report *** of theses patients having damage to the visual system, ocu lar motor nerve palsies, or central eye movement disturbances. Visual disturbanc es influence prognosis and outcome of neurological rehabilitation, and, in most cases, diagnosis and treatment require interdisciplinary care. Case report. We r eport here a 50-year-old patient who suffered from severe head trauma at age 2 0. After coming out of a 4-week coma, he suffered visual disturbances such as b lurred vision and diplopia. Visual acuity was 1.0 and the visual fields were int act. The symptoms remained unexplained for a long time. One year after the traum a, right trochlear palsy was diagnosed and surgical treatment was performed. How ever, the symptoms persisted, and one year later, a second operation was perform ed without changing the symptoms. During many years, prisms or refractive correc tions were used to improve the visual disturbances, and finally, a psychiatric t reatment was started. At age 40, the patient became presbyopic and his visual pr oblems increased, especially for reading. When he was examined for the first tim e in our consultation, corrected visual acuity was 1.0 with a small hyperphoria of the right eye. During careful examination of the eye downgaze, a conjugate pu re torsional nystagmus was observed, which disappeared in primary gaze position. Conclusion. Pure torsional nystagmus is difficult to diagnose, especially when it is provoked only by one gaze direction such as in our patient. As a sequel of the . severe head trauma with brainstem contusion, this type of nystagmus is a rare form of central vestibular nystagmus, and may by modified by head rotation or suppressed by convergence. The “treatmentof the patient’s burred vision w hen reading was easy by ordering goggles with a near part placed near the primar y gaze position and a base down prismatic correction. Reading was then