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Transient blindness following mild head trauma. Criteria for a benign outcome
1Department of Pediatrics, University of Hawaii John A. Burns School of Medicine, Honolulu.
Insights
Mild head trauma in children can cause temporary vision loss (cortical blindness). This condition, characterized by agitation and brief blindness, typically resolves fully within 24 hours.
Area of Science:
- Pediatric Neurology
- Ophthalmology
Background:
- Transient cortical blindness is a rare neurological condition.
- It can occur in children following mild head trauma.
Observation:
- Seven children (ages 3-8) in Hawaii experienced transient cortical blindness after mild head trauma.
- Key features included agitation, brief or no loss of consciousness, and rapid visual recovery.
Findings:
- Benign indicators include pediatric age, mild trauma, short duration of blindness (<24 hours), and absence of neurological deficits or skull fractures.
- Electroencephalogram (EEG) initially showed posterior slowing, normalizing over time.
Implications:
- This syndrome may be underdiagnosed due to subtle presentation.
- Early consideration is crucial for accurate diagnosis and management in pediatric head injury cases.
Abstract:
A series of seven children in Hawaii experienced transient cortical blindness following mild head trauma. All children, ages 3 through 8, recovered fully. The most prominent clinical feature was initial restlessness and agitation following relatively mild head trauma without significant loss of consciousness (LOC). One child may have experienced this several times. The clinical features associated with a benign outcome in this syndrome include: pediatric age group, mild head trauma, brief or no LOC, onset of blindness occurring within hours of the head injury, absent optokinetic nystagmus, duration of blindness less than 24 hours, agitation and restlessness, absence of skull fracture or visible cerebral injury on CT scan, absence of other neurological deficits, and EEG findings that initially show posterior slowing with subsequent normalization. Transiently fixed and dilated pupils have been described in these patients but should be viewed cautiously by clinicians in making this diagnosis, since cortical blindness is defined by sparing of the pupils. This syndrome may be underdiagnosed, since it may not be obvious that the child is blind unless the diagnosis is considered.