儿童虐待性头部创伤:视觉结果、诱发电位、弥散张量成像以及与视网膜出血的关系。

IF 2.6 4区 医学 Q2 OPHTHALMOLOGY
John P Kelly, Kenneth W Feldman, Jason N Wright, James B Metz, Avery Weiss
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引用次数: 0

摘要

目的:对儿童虐待性头部创伤(AHT)的视觉系统功能和解剖进行评价。视网膜出血之间的关系,在就诊检查与结果措施。方法:回顾性分析AHT患儿最后随访时的视力,恢复后的视觉诱发电位(VEP),弥散张量成像(DTI)枕叶内白质束和灰质的扩散指标,以及首发时视网膜出血的类型。视敏度经年龄校正后转换为最小分辨角对数(logMAR)。用客观信噪比(SNR)对vep进行评分。结果:202例AHT患者中,45例符合纳入标准。中位logMAR降至0.8(约20/125 Snellen当量),27%的患者没有可测量的视力。32%的受试者没有检测到VEP信号。在最初表现为外伤性视网膜裂或黄斑出血的受试者中,vep显著降低(p讨论:导致外伤性视网膜裂或黄斑外伤性异常的机制与显著的长期视觉通路功能障碍有关。与视力或DTI指标相比,vep更充分地捕获了黄斑和视觉皮质通路的AHT相关异常。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Pediatric abusive head trauma: visual outcomes, evoked potentials, diffusion tensor imaging, and relationships to retinal hemorrhages.

Pediatric abusive head trauma: visual outcomes, evoked potentials, diffusion tensor imaging, and relationships to retinal hemorrhages.

Pediatric abusive head trauma: visual outcomes, evoked potentials, diffusion tensor imaging, and relationships to retinal hemorrhages.

Pediatric abusive head trauma: visual outcomes, evoked potentials, diffusion tensor imaging, and relationships to retinal hemorrhages.

Purpose: Function and anatomy of the visual system were evaluated in children with abusive head trauma (AHT). The relationships between retinal hemorrhages at presentation were examined with outcome measures.

Methods: Retrospective review of data in children with AHT for 1) visual acuity at last follow-up, 2) visual evoked potentials (VEP) after recovery, 3) diffusion metrics of white matter tracts and grey matter within the occipital lobe on diffusion tensor imaging (DTI), and 4) patterns of retinal hemorrhages at presentation. Visual acuity was converted into logarithm of minimum angle of resolution (logMAR) after correction for age. VEPs were also scored by objective signal-to-noise ratio (SNR).

Results: Of 202 AHT victims reviewed, 45 met inclusion criteria. Median logMAR was reduced to 0.8 (approximately 20/125 Snellen equivalent), with 27% having no measurable vision. Thirty-two percent of subjects had no detectable VEP signal. VEPs were significantly reduced in subjects initially presenting with traumatic retinoschisis or hemorrhages involving the macula (p < 0.01). DTI tract volumes were decreased in AHT subjects compared to controls (p < 0.001). DTI metrics were most affected in AHT victims showing macular abnormalities on follow-up ocular examination. However, DTI metrics were not correlated with visual acuity or VEPS. There was large inter-subject variability within each grouping.

Discussion: Mechanisms causing traumatic retinoschisis, or traumatic abnormalities of the macula, are associated with significant long-term visual pathway dysfunction. AHT associated abnormalities of the macula, and visual cortical pathways were more fully captured by VEPs than visual acuity or DTI metrics.

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来源期刊
Documenta Ophthalmologica
Documenta Ophthalmologica 医学-眼科学
CiteScore
3.50
自引率
21.40%
发文量
46
审稿时长
>12 weeks
期刊介绍: Documenta Ophthalmologica is an official publication of the International Society for Clinical Electrophysiology of Vision. The purpose of the journal is to promote the understanding and application of clinical electrophysiology of vision. Documenta Ophthalmologica will publish reviews, research articles, technical notes, brief reports and case studies which inform the readers about basic and clinical sciences related to visual electrodiagnosis and means to improve diagnosis and clinical management of patients using visual electrophysiology. Studies may involve animals or humans. In either case appropriate care must be taken to follow the Declaration of Helsinki for human subject or appropriate humane standards of animal care (e.g., the ARVO standards on Animal Care and Use).
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