Delayed Traumatic Optic Neuropathy : A Case Report

概要

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A 20-year old woman suffered left facial trauma from a bicycle accident and was admitted to our hospital for observation due to persistent nausea and vomitting. Neurological examination on admission was normal. On the third hospital day she abruptly complained of severe left visual disturbances (corrected visual acuity : 0.08, constriction of visual field). The patient was diagnosed with traumatic optic neuropathy and the symptoms improved after a course of steroid pulse therapy. Cranial CT and MRI were unremarkable except for a small fracture on the left postero-lateral orbital wall with no evidence of optic canal fracture. Normal findings on fundoscopy and fluorescent angiography suggested posterior optic nerve injury. Traumatic optic neuropathy with delayed onset is very rare. A review of the literature and discussion of the mechanisms of injury are presented. It is important to bear in mind that even a small fracture near the optic canal can be a warning sign for such unexpected ophthalmological aggravations as this case.