Severe cranial neuropathies caused by falls from heights in children

Area of Science:

• Pediatric Ophthalmology
• Trauma Surgery
• Neurology

Background:

• Falls from heights are a leading cause of pediatric emergency department visits, often resulting in head trauma.
• Cranial neuropathies, particularly those affecting vision and eye movement, can occur following head injuries in children.

Purpose of the Study:

• To investigate the incidence of cranial neuropathies resulting from falls from heights in children.
• To describe the clinical presentation, diagnostic course, and outcomes of these injuries.

Main Methods:

• A retrospective review of computerized records from a tertiary pediatric medical center (2004-2014).
• Identification of patients with head injuries from falls, specifically those with optic and eye-motility disturbances.
• Evaluation of clinical, imaging, and outcome data for identified cases.

Main Results:

• Out of 61,968 fall-related emergency visits, 18,758 had head trauma; only 12 children (average age 6.7 years) presented with visual disturbances.
• Eight cases of traumatic optic neuropathy were diagnosed, with delays in two instances; two also had cranial nerve (CN) III injuries.
• Other findings included anisocoria, abnormal pupillary response, CN VI paralysis, and isolated CN III injury, with variable visual recovery.

Conclusions:

• Cranial neuropathies from falls are uncommon in children but carry a significant risk of visual morbidity.
• Subtle vision or ocular motility impairments, like monocular vision loss, may be overlooked in emergency settings.
• A high index of suspicion and essential assessment of pupillary response to light are vital for timely diagnosis.