Traumatic optic tract injury after low speed motor vehicle accident
M. Kurnatowski-Billion, B. Schroeder, S. Hörle
Background: Isolated optic tract injuries with homonymous hemianopia following motor vehicle accidents are rare. We report about a patient, who suffered from such an injury following a motor vehicle accident at low speed.
Case report: Our patient was a secured driver when he was involved in a low speed car collision. He suffered from a second degree whip lash injury. Immediately after the accident he complained about a severe headache. He also noticed a reduction in visual acuity (VA) of the right eye and a visual field loss. Initial examination revealed VA of OD 0.5 and OS 1.0. Visual field testing showed an incomplete, fairly congruent, homonymous, hemianopia to the right, compatible with a lesion of the left optic tract or lateral geniculate nucleus. The optic nerve heads were both unremarkable. A CCT was unremarkable as well. During the following weeks VA OD recovered to 1.0. A pallor of the optic disc was first noted after 6 months. Visual field defects persisted.
Conclusion: Even in motor vehicle accidents at low speed injuries of the optic tract can occur following whip lash injuries. Pathogenetically, a rupture of axons due to acceleration/deceleration trauma is accused. The resulting axonal damage may remain invisible to neuroradiologic diagnostic methods.
Medizinisches Zentrum für Augenheilkunde der Philipps-Universität Marburg, D-35033 Marburg