PMID- 11266692
OWN - NLM
STAT- MEDLINE
DCOM- 20010621
LR  - 20190724
IS  - 0022-510X (Print)
IS  - 0022-510X (Linking)
VI  - 185
IP  - 1
DP  - 2001 Mar 15
TI  - Damage to intracranial optic pathways in fatal closed head injury in man.
PG  - 55-62
AB  - Head injury is a leading cause of visual impairment. This is partly due to direct 
      trauma to the eye and optic nerve but much of the damage involves the 
      intracranial optic pathways. We have studied the frequency, distribution and 
      nature of the intracranial lesions of the optic pathways at autopsy in 45 cases 
      of severe closed head injury, and examined the correlation between these 
      post-mortem lesions and the ante-mortem clinical findings. Twenty-four of the 
      patients had been involved in road traffic accidents. The ages ranged from 9 to 
      88 years (mean 46.4), the Glasgow Coma Score (GCS) on admission ranged from 3 to 
      15 (mean 5), and the survival time after injury from 2.5 h to15 days (mean 3.3 
      days). Skull fractures were present in 75.6% of the cases. Histological 
      assessment included the use of immunohistochemistry for beta-amyloid precursor 
      protein (beta-APP) and the microglial marker CD68. Axonal injury of varying 
      severity was demonstrable in all cases, and in 39 (87%) the optic chiasm, tracts 
      or radiations were involved, usually in more than one region. The severity of 
      axonal injury was mild in 11 (24%), moderate in 9 (20%) and severe in 19 (42%) 
      cases. The optic radiation at the level of the trigone of the lateral ventricle 
      was particularly frequently and severely affected. The least affected parts of 
      the intracranial optic pathways were the optic chiasm and the posterior segment 
      of the optic nerve. The severity of injury to the optic pathways did not always 
      reflect severity of axonal injury elsewhere in the brain and correlated poorly 
      with the type of trauma (high- or low-velocity), presence of skull fractures or 
      evidence of raised intracranial pressure (ICP). Of the 39 patients who survived 
      more than 6 h, histological evidence of ischaemic injury to the primary optic 
      cortex was present in 26 (67%) and was severe in 12. We conclude that the visual 
      pathways are affected in a high proportion of patients with fatal closed head 
      injury, nerve fibres in the optic radiations being particularly vulnerable. The 
      findings suggest that damage to the posterior parts of the optic pathways may be 
      under-diagnosed among patients with head injury.
FAU - Perunovic, B
AU  - Perunovic B
AD  - Department of Neuropathology, Frenchay Hospital, Bristol BS161LE, UK.
FAU - Quilty, R D
AU  - Quilty RD
FAU - Athanasiou, A
AU  - Athanasiou A
FAU - Love, S
AU  - Love S
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - Netherlands
TA  - J Neurol Sci
JT  - Journal of the neurological sciences
JID - 0375403
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Axons/pathology
MH  - Brain Ischemia/mortality/pathology
MH  - Child
MH  - Female
MH  - Glasgow Coma Scale
MH  - Head Injuries, Closed/*mortality/*pathology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prevalence
MH  - Skull Fractures/mortality/pathology
MH  - Visual Pathways/injuries/*pathology
EDAT- 2001/03/27 10:00
MHDA- 2001/06/22 10:01
CRDT- 2001/03/27 10:00
PHST- 2001/03/27 10:00 [pubmed]
PHST- 2001/06/22 10:01 [medline]
PHST- 2001/03/27 10:00 [entrez]
AID - S0022510X01004634 [pii]
AID - 10.1016/s0022-510x(01)00463-4 [doi]
PST - ppublish
SO  - J Neurol Sci. 2001 Mar 15;185(1):55-62. doi: 10.1016/s0022-510x(01)00463-4.