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Lynn D Greenspan; Acquired Dysautonomia May Explain Ocular Motor Symptoms and Findings in Post-Concussion Syndrome. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2580.
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The purpose of this study is to assess the correlation between findings of autonomic dysregulation and post-concussion vision symptoms. Traumatic brain injury is associated with autonomic dysregulation (dysautonomia) causing storms of excess sympathetic tone also known as paroxysmal sympathetic hyperactivity (PSH). A high baseline state of hyper-arousal and decreased parasympathetic activity can be life-threatening in severe TBI. In this study we propose that a mild form of PSH or dysautonomia found in mild traumatic brain injury is associated with visual symptoms in post-concussion syndrome (PCS). Exaggerated sympathetic tone creates a fight or flight response which opposes the near triad reflex. Increased effort to counteract the excess sympathetic tone results in asthenopia from accommodative, convergence and ocular motor dysfunction in PCS.
A retrospective cohort study was performed on the vision clinic records from 2010-2013 in a rehabilitation hospital. Inclusion criteria:1) records of diagnosed post-concussion syndrome 2) visual findings of large or minimally reactive pupils, decreased accommodation and convergence, photophobia, peripheral visual field constriction or motion sensitivity 3) symptoms of autonomic dysregulation, including dizziness, orthostasis, erratic heart rate or pulse, exercise intolerance, nausea, anxiety, pain syndromes, or temperature dysregulation. Three symptom lists were generated based on established symptom surveys: (1) Post Concussion Symptom Survey, PCSS (2) Brain Injury Vision Symptom Survey, BIVSS and (3) a dysautonomia symptom survey. Key data points included (1) the number of subjects with both dysautonomic symptoms and post-concussion vision findings (2) the correlation between symptoms in each condition (3) the predictive value of key vision findings most highly correlated to autonomic dysregulation.
Of 712 records, 309 were post-concussive and 207 of those had at least 8 symptoms or findings related to acquired dysautonomia (67%). 190 of the 207 (91.7%) had all 5 key vision findings that most highly correlated to autonomic dysregulation.
Acquired dysautonomia explains post-concussion vision symptoms and findings in mild traumatic brain injury. Future studies will assess the benefits of treatment modalities effective in dysautonomia including medications and rehabilitation, for visual symptoms in post-concussion syndrome.
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