Traumatic Optic haldol side effects in elderly Neuropathy – EyeWiki

A CT scan of a patient found to have traumatic haldol side effects in elderly optic neuropathy of the left eye. Note that this patient has a left le fort 3 haldol side effects in elderly fracture with a left superior orbital roof fracture. The medial and inferior wall of the left orbit are haldol side effects in elderly also fractured.

There are no known risk factors for TON. In the international optic nerve trauma study, 85% of patients with indirect TON were male and the average haldol side effects in elderly age of patients with TON was 34. [1] the most common mechanisms of injury were motor vehicle accident, bike accident, fall and assault. While abusive injury is a rare cause of TON, it is an important concerns in infants.

The exact pathology of indirect TON is not well understood. The optic nerve dura is continuous with the orbital periosteum, leaving the optic nerve susceptible to transmission of force from haldol side effects in elderly blunt head trauma, particularly that affecting the superior orbital rim. Indirect TON has been hypothesized to result from shearing injury haldol side effects in elderly to the intracanalicular portion of optic nerve, which can cause axonal injury or disturb the blood supply haldol side effects in elderly of the optic nerve. It has also been suggested that the optic nerve may haldol side effects in elderly swell in the optic canal after trauma resulting in increased haldol side effects in elderly luminal pressure and secondary ischemic injury. Direct TON is presumed to be the result of tissue haldol side effects in elderly disruption secondary to foreign body or bony fragments impacting on haldol side effects in elderly the optic nerve.

The diagnosis of TON is made clinically based on history haldol side effects in elderly and ophthalmic signs. Like other optic neuropathies, patients with TON may have decreased central visual acuity, decreased color vision, an afferent pupillary defect and/or visual field deficits. It is important to remember that albeit rare, TON can be bilateral, so an afferent pupillary defect may not be seen in haldol side effects in elderly patients with bilateral injury and vision loss. The optic nerve head will appear normal initially, but optic atrophy can be seen 3-6 weeks after the initial traumatic event.

A history consistent with TON would be vision loss after haldol side effects in elderly blunt or penetrating trauma that could not be explained by haldol side effects in elderly slit lamp or dilated fundus findings. Often these patients complain of acute unilateral decrease in vision, color vision deficits, or visual field deficits. The history and subjective complaints may be delayed due to haldol side effects in elderly the impact of and treatment for other concomitant head injuries haldol side effects in elderly or other systemic comorbidities.

The initial external eye exam may show signs of orbital haldol side effects in elderly trauma or fracture (soft tissue edema, hematoma, step-off on palpation of orbital rim). Decreased visual acuity and an afferent pupillary defect (in unilateral cases) are also seen. On funduscopy, the initial optic nerve head assessment will be normal. Optic atrophy may be seen 3-6 weeks after trauma.

The clinical diagnosis of TON is made on the basis haldol side effects in elderly of a specific constellation of history and physical exam findings. Patients have a history of trauma, and complain of or are found to have significant visual haldol side effects in elderly loss, decreased color vision, visual field deficit, an afferent papillary defect, and a dilated fundus exam negative to explain these signs.

The diagnosis of TON is primarily clinical. There are some tests that can aid in the management haldol side effects in elderly and diagnosis of TON. It is important to obtain neuroimaging, usually a CT of the orbit with coronal and axial haldol side effects in elderly thin sections [1 mm]) through the optic canal are crucial to visualize the optic haldol side effects in elderly nerve as well as the optic canal and carefully evaluated haldol side effects in elderly for evidence of fracture. This can help assess for compression of the optic nerve haldol side effects in elderly by a hematoma or bony fragments impinging on the optic haldol side effects in elderly nerve, which would require surgical intervention. Automated visual field testing such as a humphrey (HVF) can be usually to characterize visual field defects/scotomas in patients with TON over time. Finally, a VEP can be used to characterize the electrical activity haldol side effects in elderly of the optic nerve.

Some authors have supported the use of high or “mega” dose corticosteroids in TON. This therapeutic regimen has been extrapolated from the national acute haldol side effects in elderly spinal cord injury study II, which showed a statistically significant improvement in neurologic outcome (motor and sensory) in a subgroup analysis of acute spinal cord injury patients haldol side effects in elderly receiving a methyprednisolone 30 mg/kg bolus within eight hours of injury, followed by 5.4 mg/kg/hr for 23 hours,. [2] subsequently however,the CRASH (corticosteroid randomization after significant head injury) study showed an increased relative risk of death in patients haldol side effects in elderly given this regimen after significant head injury. [3] the international optic nerve trauma study also did not show haldol side effects in elderly a difference in final visual acuity between patients with TON haldol side effects in elderly that were observed compared with those given steroids. [1] mouse models have shown promising results with the use of haldol side effects in elderly resveratrol after optic nerve crush injury. [4] surgery

Surgical intervention for TON was shown to not be beneficial haldol side effects in elderly in the international optic nerve trauma study. Some have supported the use of surgery in certain scenarios haldol side effects in elderly such as when a bony fragment is abutting to optic haldol side effects in elderly nerve or in the case of an optic nerve sheath haldol side effects in elderly hematoma but there is no good data supporting surgery for haldol side effects in elderly indirect TON.

In the international optic nerve trauma study, visual acuity improvement of >3 lines was seen in 57% of the untreated group, 52% of the group that received steroids alone, and 32% of the group that underwent surgery. This was not a statistically significant result.

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