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Visual Disturbances and Mild Traumatic Brain Injury (mTBI)

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Abstract

Over half of a human’s brain circuits are devoted to vision and eye movements, making it a system that can be easily compromised by a mild traumatic brain injury (mTBI). Changes in a patient’s eye movements could be a sensitive and objective biomarker of injury, and could also be useful for assessment of the pathways affected by the damage. Here, we discuss the specific dysfunctions found in afferent, efferent, and visual association pathways that may be useful for making a diagnosis of mTBI. Early diagnosis is critical to prevent further injury and to allow appropriate physical and cognitive rest to ensure full recovery, but more research is greatly needed in this area, since diagnosis of mTBI currently relies heavily on subjective complaints.

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References

  1. Heitger MH, Jones RD, MacLeod AD, Snell DL, Frampton CM, Anderson TJ. Impaired eye movements in post-concussion syndrome indicate suboptimal brain function beyond the influence of depression, malingering or intellectual ability. Brain. 2009;132(10):2850–70.

    Article  PubMed  Google Scholar 

  2. Shenton ME, Hamoda HM, Schneiderman JS, Bouix S, Pasternak O, Rathi Y, et al. A review of magnetic resonance imaging and diffusion tensor imaging findings in mild traumatic brain injury. Brain Imaging Behav. 2012;6:137–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Armstrong RA. Visual problems associated with traumatic brain injury. Clin Exp Optom. 2018;101(6):716–26.

    Article  PubMed  Google Scholar 

  4. Ventura RE, Balcer LJ, Galetta SL, Rucker JC. Ocular motor assessment in concussion: current status and future directions. J Neurol Sci. 2016;361:79–86.

    Article  PubMed  Google Scholar 

  5. Taghdiri F, Varriano B, Tartaglia MC. Assessment of oculomotor function in patients with postconcussion syndrome: a systematic review. J Head Trauma Rehabil. 2017;32(5):E55–67.

    Article  PubMed  Google Scholar 

  6. Diwakar M, Harrington DL, Maruta J, Ghajar J, El-Gabalawy F, Muzzatti L, et al. Filling in the gaps: anticipatory control of eye movements in chronic mild traumatic brain injury. Neuroimage Clin. 2015;8:210–23.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Capó-Aponte JE, Beltran TA, Walsh DV, Cole WR, Dumayas JY. Validation of visual objective biomarkers for acute concussion. Mil Med. 2018;183(suppl_1):9–17.

    Article  PubMed  Google Scholar 

  8. Heitger MH, Anderson TJ, Jones RD, Dalrymple-Alford JC, Frampton CM, Ardagh MW. Eye movement and visuomotor arm movement deficits following mild closed head injury. Brain. 2004;127(3):575–90.

    Article  PubMed  Google Scholar 

  9. Pierrot-Deseilligny C, Milea D, Müri R. Eye movement control by the cerebral cortex. Curr Opin Neurol. 2004;17(1):17–25.

    Article  PubMed  Google Scholar 

  10. Shah-Basak PP, Urbain C, Wong S, da Costa L, Pang EW, Dunkley BT, et al. Concussion alters the functional brain processes of visual attention and working memory. J Neurotrauma. 2018;35(2):267–77.

    Article  PubMed  Google Scholar 

  11. Guay S, De Beaumont L, Drisdelle BL, Lina J-M, Jolicoeur P. Electrophysiological impact of multiple concussions in asymptomatic athletes: a re-analysis based on alpha activity during a visual-spatial attention task. Neuropsychologia. 2018;108:42–9.

    Article  PubMed  Google Scholar 

  12. Heitger MH, Anderson TJ, Jones RD. Saccade sequences as markers for cerebral dysfunction following mild closed head injury. Prog Brain Res. 2002;140:433–48.

    Article  CAS  PubMed  Google Scholar 

  13. Heitger MH, Jones RD, Anderson TJ. A new approach to predicting postconcussion syndrome after mild traumatic brain injury based upon eye movement function. Conf Proc IEEE Eng Med Biol Soc. 2008;2008:3570–3.

    PubMed  Google Scholar 

  14. Barnett BP, Singman EL. Vision concerns after mild traumatic brain injury. Curr Treat Options Neurol. 2015;17(2):329.

    Article  PubMed  Google Scholar 

  15. Padula WV, Nelson CA, Benabib R, Yilmaz T, Krevisky S. Modifying postural adaptation following a CVA through prismatic shift of visuo-spatial egocenter. Brain Inj. 2009;23(6):566–76.

    Article  PubMed  Google Scholar 

  16. Halterman CI, Langan J, Drew A, Rodriguez E, Osternig LR, Chou L-S, et al. Tracking the recovery of visuospatial attention deficits in mild traumatic brain injury. Brain. 2006;129(3):747–53.

    Article  PubMed  Google Scholar 

  17. Atkins EJ, Newman NJ, Biousse V. Post-traumatic visual loss. Rev Neurol Dis. 2008;5(2):73–81.

    PubMed  PubMed Central  Google Scholar 

  18. Greenwald BD, Kapoor N, Singh AD. Visual impairments in the first year after traumatic brain injury. Brain Inj. 2012;26(11):1338–59.

    Article  PubMed  Google Scholar 

  19. Ventura RE, Balcer LJ, Galetta SL. The neuro-ophthalmology of head trauma. Lancet Neurol. 2014;13(10):1006–16.

    Article  PubMed  Google Scholar 

  20. American Academy of Opthalmology. The patient with supranuclear disorders of coular motility. In: Basic and clinical science course: neuro-opthalmology section 5. San Francisco: American Academy of Opthalmology; 2017. p. 211–28.

    Google Scholar 

  21. Roper-Hall G, Cruz OA, Chung SM. The post-concussion syndrome: influence on binocular function. J AAPOS. 2015;19(4):e58.

    Article  Google Scholar 

  22. Straube A, Bronstein A, Straumann D, European Federation of Neurologic Societies. Nystagmus and oscillopsia. Eur J Neurol. 2012;19(1):6–14.

    Article  CAS  PubMed  Google Scholar 

  23. Suh M, Basu S, Kolster R, Sarkar R, McCandliss B, Ghajar J. Increased oculomotor deficits during target blanking as an indicator of mild traumatic brain injury. Neurosci Lett. 2006;410(3):203–7.

    Article  CAS  PubMed  Google Scholar 

  24. Suh M, Kolster R, Sarkar R, Mccandliss B, Ghajar J. Deficits in predictive smooth pursuit after mild traumatic brain injury. Neurosci Lett. 2006;401:108–13.

    Article  CAS  PubMed  Google Scholar 

  25. Swenson R. Chapter 11: the cerebral cortex. In: Swenson R, editor. Review of clinical and functional neuroscience. Hanover: Dartmouth Medical School; 2006.

    Google Scholar 

  26. Sohlberg MM, Griffiths GG, Fickas S. An evaluation of reading comprehension of expository text in adults with traumatic brain injury. Am J Speech Lang Pathol. 2014;23(2):160.

    Article  PubMed  Google Scholar 

  27. Belanger HG, Curtiss G, Demery JA, Lebowitz BK, Vanderploeg RD. Factors moderating neuropsychological outcomes following mild traumatic brain injury: a meta-analysis. J Int Neuropsychol Soc. 2005;11:215–27.

    Article  PubMed  Google Scholar 

  28. Ivins BJ, Kane R, Schwab K. Performance on the automated neuropsychological assessment metrics in a nonclinical sample of soldiers screened for mild TBI after returning from Iraq and Afghanistan: a descriptive analysis. J Head Trauma Rehabil. 2009;24(1):24–31.

    Article  PubMed  Google Scholar 

  29. Maruta J, Suh M, Niogi SN, Mukherjee P, Ghajar J. Visual tracking synchronization as a metric for concussion screening. J Head Trauma Rehabil. 2010;25(4):293–305.

    Article  PubMed  Google Scholar 

  30. Hecimovich M, King D, Dempsey A, Gittins M, Murphy M. In situ use of the King-Devick eye tracking test and changes seen with sport-related concussion: saccadic and blinks counts. Phys Sportsmed. 2019;47(1):78–84.

    Article  PubMed  Google Scholar 

  31. Akhand O, Rizzo J-R, Rucker JC, Hasanaj L, Galetta SL, Balcer LJ. History and future directions of vision testing in head trauma. J Neuroophthalmol. 2019;39(1):68–81.

    Article  PubMed  Google Scholar 

  32. Purves D, Augustine GJ, Fitzpatrick D, et al. Type of eye movements and their functions. In: Neuroscience. 2nd ed. Sunderland: Sinauer Associates; 2001.

    Google Scholar 

  33. Sussman ES, Ho AL, Pendharkar AV, Ghajar J. Clinical evaluation of concussion: the evolving role of oculomotor assessments. Neurosurg Focus. 2016;40(4):E7.

    Article  PubMed  Google Scholar 

  34. Barton JJS, Cherkasova MV, Lindgren K, Goff DC, Intriligator JM, Manoach DS. Antisaccades and task switching: studies of control processes in saccadic function in normal subjects and schizophrenic patients. Ann N Y Acad Sci. 2002;956:250–63.

    Article  PubMed  Google Scholar 

  35. Ventura R, Balcer L, Galetta S. The concussion toolbox: the role of vision in the assessment of concussion. Semin Neurol. 2015;35(05):599–606.

    Article  PubMed  Google Scholar 

  36. Galetta KM, Morganroth J, Moehringer N, Mueller B, Hasanaj L, Webb N, et al. Adding vision to concussion testing. J Neuroophthalmol. 2015;35(3):235–41.

    Article  PubMed  Google Scholar 

  37. Oride MKH, Marutani JK, Rouse MW, DeLand PN. Reliability study of the Pierce and King Devick saccade tests. Am J Optom Physiol Opt. 1986;63(6):419–24.

    Article  CAS  PubMed  Google Scholar 

  38. Galetta KM, Brandes LE, Maki K, Dziemianowicz MS, Laudano E, Allen M, et al. The King-Devick test and sports-related concussion: study of a rapid visual screening tool in a collegiate cohort. J Neurol Sci. 2011;309(1–2):34–9.

    Article  PubMed  Google Scholar 

  39. Galetta KM, Barrett J, Allen M, Madda F, Delicata D, Tennant AT, et al. The King-Devick test as a determinant of head trauma and concussion in boxers and MMA fighters. Neurology. 2011;76(17):1456–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Lin TP, Adler CH, Hentz JG, Balcer LJ, Galetta SL, Devick S. Slowing of number naming speed by King-Devick test in Parkinson’s disease. Parkinsonism Relat Disord. 2014;20(2):226–9.

    Article  PubMed  Google Scholar 

  41. Torres DM, Galetta KM, Phillips HW, Dziemianowicz EMS, Wilson JA, Dorman ES, et al. Sports-related concussion: anonymous survey of a collegiate cohort. Neurol Clin Pract. 2013;3(4):279–87.

    Article  PubMed  PubMed Central  Google Scholar 

  42. King D, Clark T, Gissane C. Use of a rapid visual screening tool for the assessment of concussion in amateur rugby league: a pilot study. J Neurol Sci. 2012;320(1–2):16–21.

    Article  PubMed  Google Scholar 

  43. Leong DF, Balcer LJ, Galetta SL, Liu Z, Master CL. The King-Devick test as a concussion screening tool administered by sports parents. J Sports Med Phys Fitness. 2014;54(1):70–7.

    CAS  PubMed  Google Scholar 

  44. Murray NG, D’Amico NR, Powell D, Mormile ME, Grimes KE, Munkasy BA, et al. ASB clinical biomechanics award winner 2016: assessment of gaze stability within 24–48 hours post-concussion. Clin Biomech. 2017;44:21–7.

    Article  Google Scholar 

  45. Raikes AC, Schaefer SY, Studenka BE. Concussion history is negatively associated with visual-motor force complexity: evidence for persistent effects on visual-motor integration. Brain Inj. 2018;32(6):747–54.

    Article  PubMed  Google Scholar 

  46. Master C, Storey E, Grady M. Relationship between patient-reported visual symptoms and physician-detected visual deficits after concussion. Arch Phys Med Rehabil. 2018;99(11):e147.

    Article  Google Scholar 

  47. Bin Zahid A, Hubbard ME, Lockyer J, Podolak O, Dammavalam VM, Grady M, et al. Eye tracking as a biomarker for concussion in children. Clin J Sport Med. 2018;1 [Epub ahead of print].

    Google Scholar 

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Correspondence to Jack W. Tsao .

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Ditta, L.C. et al. (2020). Visual Disturbances and Mild Traumatic Brain Injury (mTBI). In: Tsao, J. (eds) Traumatic Brain Injury. Springer, Cham. https://doi.org/10.1007/978-3-030-22436-3_12

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  • DOI: https://doi.org/10.1007/978-3-030-22436-3_12

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-22435-6

  • Online ISBN: 978-3-030-22436-3

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