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Medical Forum / General / Vision / April 2005Wife had brain injury, now has blurred vision
On September 1, 2002, my wife had an accident which resulted in a severe brain injury to the right side of the head. One of the results of the injury was the left eye turned towards her nose and would not move toward the center. She had two surgeries last year and the eye will now move to just left of center and all the way to the right. She has been complaining of getting very dizzy mostly when she is standing or walking but sometimes when she is sitting. She was checked out by a neuro-opthomologist and he said the current prescription for her glasses was still fine and said that she may still be recovering from the surgery she had in October to put in a skull plate. Then she was checked out by an audiology specialist and he asked her to describe her dizziness and decided it was more of a blurred vision problem. We are waiting for an appointment for her to get some "vestibular testing" but after doing some research on the internet, I am wondering if I should skip the vestibular testing and get her an appointment with a "functional optometrist" or "neuro-optometrist" instead of going back to a neuro ophthalmologist. Also, I came across some web sites that sell software for vision therapy. Are these programs any good? Any comments appreciated. Thanks, David >and get her an appointment with a "functional optometrist" >or "neuro-optometrist" instead of going back to a neuro ophthalmologist. [quoted text clipped - 5 lines] > >Thanks, David Stick with MDs---but change if you are not satisfied. (This isn't really an eye problem but a neurological problem) >>and get her an appointment with a "functional optometrist" >>or "neuro-optometrist" instead of going back to a neuro [quoted text clipped - 9 lines] > Stick with MDs---but change if you are not satisfied. > (This isn't really an eye problem but a neurological problem) Aw, gee thanks for the vote of confidence in optometry. Now just what is it that the neuro-ophthalmologist is going to be able to offer? People go through rehab with phycial therapists all the time following "neurological" injuries. The neurologist doesn't conduct the PT. Same relationship holds in this situation. DrG >>>and get her an appointment with a "functional optometrist" >>>or "neuro-optometrist" instead of going back to a neuro [quoted text clipped - 18 lines] > >DrG Below is a paragraph from one of the web pages I found while looking around the net. I found some of the statements very familiar except in our case there is no litigation involved and my wife's vision is blurry not double vision (unless the double vision is so minor that it just makes her vision seem blurry). The following paragraph is from the web site: http://www.headinjurylaw.com/vision2.htm The software of the visual system consists of the neural wiring of the optic nerve, the optic chiasm, the optic tracts and their offshoots, the lateral geniculate nucleus (LGN) of the thalamus, the optic radiations from the LGN and the visual cortex located at the back of the brain in the occipital lobe. The wiring is made up of thin, delicate axons and the visual processing units in the LGN and visual cortex consist of tiny living cells with fragile membranes. The axons are vulnerable to stretch/strain damage and the cells are vulnerable to shaking or perturbation which can damage or kill them. Closed head trauma causing "mild tbi" (with minimal or no loss of consciousness) frequently traumatizes the software of the visual system with disruption of binocular vision such as blurry or double vision. However, closed head brain trauma which damages the vision software causes no detectable mechanical damage to eye structures and no cranial nerve damage with easily detectible strabismus or hyperopia. The patient's eyes look fine. He can still read an eye chart. His brain shows no bleeding on CT or swelling/compression on MRI. In such cases, and there are many thousands every year, the typical ophthalmologist chalks up the patient's complaints of double vision to "hysteria" or "malingering," especially when they learn a claim has been filed. This not only wounds the feelings of the patients (who know they are telling the truth, their vision really is double) but deprives them of necessary treatment and may ruin their personal injury lawsuit or workers compensation claim without good reason. Thanks, David 1. The brain injury described (so vaguely) does suggest DAI (diffuse axonal injury) did arise. DAI is a very useful marker for damage done via TBI. There are some scans that can detect DAI, that may be worth persuing but it will only confirm DAI, not much that can be done about it. Vision problems are not uncommon post tbi though the exact reasons remain unclear. Dizziness also occurs post tbi. 2. Don't skip the vestibular testing, should at least be checked out. 3. The internet is replete with miracle cures, enter at your own risk. Caveat emptor. 4. Does your wife *always* experience double vision and dizziness. There may be some merit in trying to determine what makes it worse, the frequency of the symptoms and any correlations noted. Did the symptom appear before the corrective surgery? 5. Given the injury you should consider some dietary changes that may aid recovery. Nothing spectacular, mostly common sense, but post TBI some dietary changes can be beneficial for recovery. Don't fall for the "miracle herbs fallacy", in fact don't even try the same without first consulting the doctor. Some non-traditional forms of therapy can help but you need to be very careful about this. MUCH wiser to go for an optimal diet that facilitates brain recovery. http://www.neuroskills.com/index.shtml?main=/edu/ceumtbi18.shtml Check out in above link: Vision and TBI under directories pull down menu on the left. http://www.brainplace.com/bp/prescriptions/default.asp This site has a variety of links related to keeping the brain healthy. > >>>and get her an appointment with a "functional optometrist" > >>>or "neuro-optometrist" instead of going back to a neuro [quoted text clipped - 66 lines] > > Thanks, David >>and get her an appointment with a "functional optometrist" >>or "neuro-optometrist" instead of going back to a neuro ophthalmologist. [quoted text clipped - 9 lines] >Stick with MDs---but change if you are not satisfied. >(This isn't really an eye problem but a neurological problem) Thanks for your suggestion. She has seen two neuro ophthalmologists. One atter the nerve surgery on her left eye and another after the last surgery to install the skull plate. That is why I am considering other options. Thanks, David Take a look at this for starters. http://www.iblindness.org/books/bates/ >Take a look at this for starters. >http://www.iblindness.org/books/bates/ Thanks, I will check it out. David but don't behave as the people at that site, they are true ignorants, as all the other professionals in this field. this is a matter of spiritual quest. http://thecentralfixation.com > On September 1, 2002, my wife had an accident which resulted in a severe > brain [quoted text clipped - 25 lines] > optometrist" > or "neuro-optometrist" instead of going back to a neuro ophthalmologist. Dizziness is almost always due to a vestibular problem, get that done first. Vision training by optometrists is directed primarily at improving binocular vision. Your wife does not have binocular vision due to major damage to the 6th cranial nerve which controls the lateral rectus of her left eye; the muscle is not working and will not be made to work with vision training. Sometimes the nerve recovers after injury, recovery may take months to years. The neuro ophthalmologist who knows the details of your wife's injury and surgeries can tell you whether any recovery is expected. > Also, I came across some web sites that sell software for vision therapy. > Are > these programs any good? Usually these programs are used in conjunction with a vision training person (either optometrist or occupational therapist) who knows the details of your wife's injury and could tell you whether a program would work and recommend a specific one. Again, most are directed at improving binocular fusion which your wife will likely not achieve due to the nerve damage. Dr Judy > Any comments appreciated. > > Thanks, David HI Dr. Judy, Thanks for your suggestions. David >> On September 1, 2002, my wife had an accident which resulted in a severe >> brain [quoted text clipped - 51 lines] >> >> Thanks, David Do a simple test: cover one eye with an eyepatch. Is the dizziness and/or visual blur still the same? If yes, then it is unrelated to binocular eye cooperation problems, as using one eye eliminates that. If the blur is gone, try the other eye - is the blur related to one of the eyes (probably not.) If there is still dizziness with one eye covered, try closing BOTH eyes. If there is still dizziness, then it is definitedly NOT related to the eyes, and they are out of the picture when they are both closed. Regarding Dr. Judy's comment that she does not have binocular vision - may not be entirely true. if the muscle surgery (sounds like a transposition of Foster procedure for total 6th nerve paralysis) was successful, and the eye is aligned in primary position, even though there is lateral gaze limitation, there is no reason not to have binocular vision where the eyes are aligned. Of course, if the visual axes do no line up at all, then, no, there is no binocular vision. These muscle procedures can restore or increase the field of single binocular vision, or move it more towards the center, although the extent will be limited. David Robins, MD Board certified Ophthalmologist Pediatric and strabismus subspecialty Member of AAPOS (American Academy of Pediatric Ophthalmology and Strabismus) On 12/14/04 8:49 PM, in article 20041214224955.11961.00001619@mb-m16.aol.com, "Dyhibb" <dyhibb@aol.com> wrote: > On September 1, 2002, my wife had an accident which resulted in a severe brain > injury to the right side of the head. One of the results of the injury was the [quoted text clipped - 23 lines] > > Thanks, David > If there is still dizziness with one eye covered, try closing BOTH eyes. If > there is still dizziness, then it is definitedly NOT related to the eyes, > and they are out of the picture when they are both closed. Dizziness is ALWAYS created by the eyes. Now you see how these doctors are completely ignorant of the truth? This test is very easy: if he feels dizziness with eyes closed, the answer is that with eyes closed the strain is most. The patient should learn some methods for resting his eyes and mind and find a way to improve his condition. Little improvements bring forth big improvements. Eyeglasses must be avoided. http://TheCentralFixation.com It seems to me that with so many visits to the neuro-ophthalmologist, that any problem with visual acuity would have been documented. Go figure. DrG |
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