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   Table of Contents      
ORIGINAL ARTICLE
Year : 1991  |  Volume : 39  |  Issue : 1  |  Page : 20-21

Visual evoked potentials in optic nerve injury--does it merit to be mentioned?


Dept. of Neurosurgery, Neurosciences Centre, All Institute of Medical Sciences, New Delhi, India

Correspondence Address:
A K Mahapatra
Dept. of Neurosurgery, Neurosciences Centre, All Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


PMID: 1894339

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  Abstract 

The value of Visual Evoked Potentials (VEP) in the management of indirect optic nerve injury was prospectively studied in 78 patients. The initial VEPs were normal in 10, abnormal in 29 and absent in 39 patients. All 10 patients with normal VEP showed visual recovery. Amongst 29 patients with abnormal VEP, 26 (86.6%) showed improvement. In 39 patients initial VEPs showed no wave, however, subsequent VEP recordings demonstrated wave formation. Thus in 31 patients repeated VEP recordings failed to demonstrate wave formation, and none of them improved. This study, thus brings out the high predictive value of both positive and negative VEPs.


How to cite this article:
Mahapatra A K. Visual evoked potentials in optic nerve injury--does it merit to be mentioned?. Indian J Ophthalmol 1991;39:20-1

How to cite this URL:
Mahapatra A K. Visual evoked potentials in optic nerve injury--does it merit to be mentioned?. Indian J Ophthalmol [serial online] 1991 [cited 2019 Jun 17];39:20-1. Available from: http://www.ijo.in/text.asp?1991/39/1/20/24489



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  Introduction Top


Optic nerve injury is a rare complication of closed head injury. Except for an isolated series by Fukado [1],[2] no other large series is available [3],[4],[5]. The recent studies reported over the last two years consisted of fewer than 50 cases [3],[4],[5],[6]sub .The present report prospectively analyses the VEP findings in 78 patients with optic nerve injury and justifies it's role in predicting the outcome.


  Material and methods Top


Over a 41/~ year period (Jan. 1984 through July 1988) 78 patients with optic nerve injury were managed at the neurosurgery department of AIIMS. They entered into a prospective study with an aim to evaluate the role of VEP in the management of optic nerve injury. VEPs were performed routinely by using the Nicolet 1170 model or Nicolet Compact four model. VEPs were recorded either by using Pattern reversal method or by Light Emitting Diodes (LED). LED was used in unconscious or un­cooperative patients and helped in establishing the diagnosis in those in whom visual loss was suspected. VEPs were performed within 48 hours of initial evalua­tion and were repeated within 7 to 10 days to assess the electrophysiological improvement. VEPs were categorised as normal, abnormal or absent [Figure - 1] a & b depending upon their wave formation and latencies. Latencies longer than 2 SD of the control value were considered as abnormal. Initial VEPs were normal in 10, abnormal in 29 and absent in 39 patients. Overall im­provement occurred in 29 (56%) patients. All the 10 patients with normal VEP recovered. Among 29 patients with abnormal VEP, 26 (86.6%) showed visual improve­ment. Thus 6 out of 39 patients (92.2%) with a positive VEP wave had visual improvement ultimately. Thirty-nine patients with initial absent VEPs 31 of whom had repeated absent VEP waves had no subsequent im­provement [Table 1.


  Discussion Top


Optic nerve injury is a rare condition and except for the series by Mahapatra & Bhatia [3] no other prospective study is available. The pathogenesis is not clear and the ideal management is yet to be established. These days VEPs are routinely performed to assess the integrity of the anterior visual pathways. However, not much litera­ture is available on the role of VEP in the management of optic nerve injury. [3],[4],[7] Recent reports published in the literature do not even mention the role of such a valuable investigation [2],[5],[6] Shaken et al in 1982 [7] reported a patient in whom repeated VEPs were performed. Mahapatra and Bhatia [3] in a recent study of 45 patients with optic nerve injury established the predictive value of VEPs in patients with traumatic unilateral blindness. They reported improvement in 90% of patients with positive P 100 waves. Nau et al in 1987 [4] reported 14 patients in whom VEPs were performed. Surprisingly enough they did not find out the importance of a positive VEP, however, they concluded the role of negative VEPs as an indicator of poor prognosis. In the present study 44 patients had visual improvement (56%). All the 10 patients with normal VEP had good recovery. Thirty-six out of 39 patients with a positive P 100 wave had significant visual improvement and none of the 31 patients with repeatedly absent VEP had shown visual recovery. Thus the present study established the role of both positive and negative VEPs in the diagnosis and in predicting the outcome. In unconscious patients VEPs did help in establishing the diagnosis of optic nerve injury.

 
  References Top

1.
Fukado Y. Results in 400 cases of surgical decompression of the optic nerve. Mod Prob Ophthalmol. 14: 474-81. 1975.  Back to cited text no. 1
    
2.
Fukado. Y. Microsurgical Transethmoidal optic nerve decompression Experience in 700 cases. In: Sami M & Jannetta P (ads). The cranial nerve. New York : Springer Verlag, 125-28, 1981.  Back to cited text no. 2
    
3.
Mahapatra A.K.. Bhatia R. Predictive value of visual evoked potentials in unilateral optic nerve injury. Surg Neurol, 31 : 339-342. 1989.  Back to cited text no. 3
    
4.
Nau HE, Gerhard L. Foerster M, Nahser BC, Reinhardt. V. Joka Th. Optic nerve trauma: Clinical. electrophysiological and histological remarks. Acta Neurochir (Wien), 89 : 16-27, 1987.  Back to cited text no. 4
    
5.
Nobel MJ, MvFadzean R. Indirect injury to optic nerve and optic chiasma. Neuro-ophthalmol, 7: 341 -348. 1987.  Back to cited text no. 5
    
6.
Millesi W. Hollamann K, Funder J. Traumatic lesions of the optic nerve. Acta Neurochir (Wien), 93 : 50-54, 1988.  Back to cited text no. 6
    
7.
Shaked A, Hadani M, Feinsod M. CT and VER follow up reversible visual loss with fracture of optic canal. Acta Neurochir (Wien), 62 : 91-94, 1982.   Back to cited text no. 7
    


    Figures

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    Tables

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Introduction
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Discussion
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