severe blow to the back of the head (aimed at current medics!)

Is a bilateral central scotoma secondary to a severe blow to the back of the head reversible? What other symptoms might one present after such injury?

Reply 1

Danby

This question clearly wasn't aimed at me.
However, I have the luxury of not being responsible for my answers and so I can afford to state the bleedin' obvious.
What sort of examination were you hoping the other symptoms would show up with?
What you need to do is decide whether this is an ocular or a neurological problem.
So, you don't expect a central scotoma to mean a retinal detachment or for that matter a bleed so I'm thinking you've done ophthalmoscopy and perhaps slit lamp examination and found nothing much amiss...
The primary method of localizing lesions of the optic pathways is by central; and peripheral field examination. Guess you figured that out too...
You say bilateral field loss and I say chiasmal lesion.
On the other hand I guess your patient has retinitis pigmentosa.

Reply 2

Comp_Genius

presumbly if one suffers a blow to the head the central scotomas would be because the occipital poles are damaged, so it's central. but I am just wondering as a result of trauma to the back of the head, what symptoms might a patient present with?

Reply 3

belis

It depends really. Here are some possible symptoms but they are not specific to the injury to the back of the head, rather head injury in general:

Loss of consciousness, confusion, or drowsiness
Low breathing rate or drop in blood pressure
Convulsions
Fracture in the skull or face, facial bruising, swelling at the site of the injury, or scalp wound
Fluid drainage from nose, mouth, or ears (may be clear or bloody)
Severe headache
Initial improvement followed by worsening symptoms
Irritability (especially in children), personality changes, or unusual behavior
Restlessness, clumsiness, or lack of coordination
Slurred speech or blurred vision
Inability to move one or more of your limbs
Stiff neck or vomiting
Pupil changes
Inability to hear, see, taste, or smell

Reply 4

Danby

OK my little white cells have been at this.
I admit I forgot the two other causes of these scotomas.
Aged related macular degeneration and glaucoma.
Acute glaucoma could result from a shock to the head but it would be very painful.
The neuro possibility could be a small burst anurism in the area of the optical chiasma.

Reply 5

Danby

The problem from this perspective is that people often have a slowly degenerative disease and then there is a dramatice event that brings them to the doctor and they say the degenerative symptoms only started at the time of the trauma.
Answering the question. I don't think the prognosis is good for recovery. That would almost certainly only happen if pressure on a chiasmic lession sunsided. Only other causes are progressive.
Check IOP intra ocular pressure - tonometer.

Reply 6

Fluffy

Why? Is this a purely 'academic' question? If not, it should be addressed by a suitably qualifed person, not a medical student.

Reply 7

cookie monster

Fluffy

Why? Is this a purely 'academic' question? If not, it should be addressed by a suitably qualifed person, not a medical student.

Exactly.

Don't forget, guys - anyone can Google :wink:

Reply 8

Danby

Well let's assume that it is a purely academic question and just point out that although ret pig is commonly known as tunnel vision you actually get a ring scotoma.
This mean that the scotoma is peri central and not central. I.E. the vision closes in from about 40 degrees out sparing the actual periphery.