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      Optic nerve avulsion: A case report

      case-report

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          Abstract

          A case of a 13-year-old girl after being injured on the left eyeball by a stick from a cage, is presented. Along vitreous haemorrhage, retinal oedema and ischaemia, the disc was replaced by a cavity. Multimodal imaging was performed, which confirmed the optic nerve damage. The eye had no light perception anymore. Our case is a demonstration for complete avulsion of the optic nerve after blunt injury.

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          Most cited references37

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          Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury (MRC CRASH trial): randomised placebo-controlled trial.

          Ian Roberts, David Yates, Peter Sandercock … (2004)
          Corticosteroids have been used to treat head injuries for more than 30 years. In 1997, findings of a systematic review suggested that these drugs reduce risk of death by 1-2%. The CRASH trial--a multicentre international collaboration--aimed to confirm or refute such an effect by recruiting 20000 patients. In May, 2004, the data monitoring committee disclosed the unmasked results to the steering committee, which stopped recruitment. 10008 adults with head injury and a Glasgow coma score (GCS) of 14 or less within 8 h of injury were randomly allocated 48 h infusion of corticosteroids (methylprednisolone) or placebo. Primary outcomes were death within 2 weeks of injury and death or disability at 6 months. Prespecified subgroup analyses were based on injury severity (GCS) at randomisation and on time from injury to randomisation. Analysis was by intention to treat. Effects on outcomes within 2 weeks of randomisation are presented in this report. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN74459797. Compared with placebo, the risk of death from all causes within 2 weeks was higher in the group allocated corticosteroids (1052 [21.1%] vs 893 [17.9%] deaths; relative risk 1.18 [95% CI 1.09-1.27]; p=0.0001). The relative increase in deaths due to corticosteroids did not differ by injury severity (p=0.22) or time since injury (p=0.05). Our results show there is no reduction in mortality with methylprednisolone in the 2 weeks after head injury. The cause of the rise in risk of death within 2 weeks is unclear.
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            A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study.

            Richard Bracken, J Maroon, James W. Collins … (1990)
            Studies in animals indicate that methylprednisolone and naloxone are both potentially beneficial in acute spinal-cord injury, but whether any treatment is clinically effective remains uncertain. We evaluated the efficacy and safety of methylprednisolone and naloxone in a multicenter randomized, double-blind, placebo-controlled trial in patients with acute spinal-cord injury, 95 percent of whom were treated within 14 hours of injury. Methylprednisolone was given to 162 patients as a bolus of 30 mg per kilogram of body weight, followed by infusion at 5.4 mg per kilogram per hour for 23 hours. Naloxone was given to 154 patients as a bolus of 5.4 mg per kilogram, followed by infusion at 4.0 mg per kilogram per hour for 23 hours. Placebos were given to 171 patients by bolus and infusion. Motor and sensory functions were assessed by systematic neurological examination on admission and six weeks and six months after injury. After six months the patients who were treated with methylprednisolone within eight hours of their injury had significant improvement as compared with those given placebo in motor function (neurologic change scores of 16.0 and 11.2, respectively; P = 0.03) and sensation to pinprick (change scores of 11.4 and 6.6; P = 0.02) and touch (change scores, 8.9 and 4.3; P = 0.03). Benefit from methylprednisolone was seen in patients whose injuries were initially evaluated as neurologically complete, as well as in those believed to have incomplete lesions. The patients treated with naloxone, or with methylprednisolone more than eight hours after their injury, did not differ in their neurologic outcomes from those given placebo. Mortality and major morbidity were similar in all three groups. We conclude that in patients with acute spinal-cord injury, treatment with methylprednisolone in the dose used in this study improves neurologic recovery when the medication is given in the first eight hours. We also conclude that treatment with naloxone in the dose used in this study does not improve neurologic recovery after acute spinal-cord injury.
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              Erythropoietin as an antiapoptotic, tissue-protective cytokine.

              M Brines, P. Ghezzi (2004)
              Erythropoietin (EPO) increases the number of circulating erythrocytes primarily by preventing apoptosis of erythroid progenitors. In addition to this proerythroid action, results of recent studies show that systemically administered EPO is protective in vivo, in several animal models of neuronal injury. In vitro, EPO prevents neuronal apoptosis induced by a variety of stimuli. This review summarizes the neuroprotective actions of EPO and discusses the underlying mechanisms in terms of signal transduction pathways involved. The understanding of these mechanisms will help differentiate the neuroprotective actions of EPO from its role in the bone marrow.
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                Author and article information

                Contributors
                A. Gyenes
                Journal
                Journal ID (publisher-id): 2066
                Title: Developments in Health Sciences
                Abbreviated Title: DHS
                Publisher: Akadémiai Kiadó (Budapest )
                ISSN (Print): 2630-9378
                ISSN (Electronic): 2630-936X
                Publication date (Print): 19 April 2021
                Publication date (Electronic): 11 March 2021
                Volume: 3
                Issue: 3
                Pages: 72-76
                Affiliations
                [1 ] Department of Ophthalmology, Semmelweis University , Budapest, Hungary
                [2 ] MR Research Center, Semmelweis University , Budapest, Hungary
                Author notes
                [* ]Corresponding author. Department of Ophthalmology, Semmelweis University , Mária utca 39, Budapest, H-1085, Budapest, Hungary. E-mail: drgyenesandrea@ 123456gmail.com
                Article
                DOI: 10.1556/2066.2020.00013
                SO-VID: 48579b8a-abba-485d-a9bc-b17f27cc174d
                Copyright © © 2021 The Author(s)
                License:

                Open Access. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited, a link to the CC License is provided, and changes – if any – are indicated. (SID_1)

                History
                Date received : 05 May 2020
                Date accepted : 19 February 2021
                Page count
                Figures: 5, Equations: 0, References: 38, Pages: 05
                Custom metadata
                SID 1

                ScienceOpen disciplines: Medicine,Immunology,Health & Social care,Microbiology & Virology,Infectious disease & Microbiology
                Keywords: injury,avulsion,optic nerve
                Data availability:
                ScienceOpen disciplines: Medicine, Immunology, Health & Social care, Microbiology & Virology, Infectious disease & Microbiology
                Keywords: injury, avulsion, optic nerve

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