|
« ความเห็นที่ #8 เมื่อ: 04/13/11 เวลา 01:46:52 » |
 
|
on 04/12/11 เวลา 23:43:24, doctor know nothing wrote:
อาการคืออะไรครับเช่นตามัวมองไม่เห็น เห็นภาพไม่ชัด หรือเห็นรูปร่างผิดปกติ
สงสัยอยู่ว่าทำไมใช้คำว่าเส้นประสาทตาขาด น่าจะใช้คำว่าได้รับบาดเจ็บมากกว่า
ซึ่งพบน้อยมากลองอ่านดูนะOptic nerve injury is a rare condition, nevertheless it is important as it could cause significant visual loss and even blindness. In India it is estimated that over 500,000 people suffer from some form of head injury every year. Given a 2% incidence of optic nerve injury in association with head injury, over 10,000 would develop optic nerve injury. Only few large series of optic nerve injury are reported in the literature and all of them have included optic nerve injury in general. We have taken a specific group of patients, those with NLP, and analysed the prognosis for the group, as an independent subgroup.
In the absence of a prospective randomised study, management strategies remain controversial. The literature suggests that spontaneous recovery occurs in 25 to 55% of the cases. The number of patients with NLP vision in these studies were small. Lesse reported a study of 33 patients with indirect optic nerve injury wherein there were 6 patients with NLP and two persons showed improvement. However, the number was too small to contribute to any definite conclusions. Data from uncontrolled studies suggest that high-dose steroids may improve the outcome However, no prospective study has compared medical and expectant treatment. Megadose steroids reduce CNS oedema, microcirculatory spasm and neural necrosis allowing small nutrient vessels that feed the nerve to regain patency. We have also used steroids with possible benefit to our patients. In the present study use of dexamethasone or methyl predinisolone had a similar effect.
Routine surgical decompression of the optic canal has been recommended by many authors. Fukado has reported over 700 cases. In the initial 400 cases in his series, all improved following surgery. However, the subsequent 300 cases had an improvement rate of only 40%. However, his work suffers from lack of selection criteria and clinical details. The frequency of improvement following surgery ranges from 12-79%.
Our study supports the views expressed by Fujitani et al and Lessel in that associated injuries and fractures do not influence the outcome. Nau et al retrospectively analysed VEP in 14 patients and found the usefulness of an absent VEP in predicting a poor visual outcome. They, however, failed to find a good correlation between positive wave and recovery. Our previous studies,had shown that none of the patients with follow-up normal VEP had good recovery. Thus, it proved the role of both positive and absent VEP waves in predicting the outcome. Improvement of negative VEPs or abnormal to normal VEPs was indicative of visual recovery.
สรุปการรักษามีทั้งการเฝ้าดูเฉยๆ,ให้สเตียรอยและการผ่าตัดลดการกดเบียดบางรา ยที่เหมาะสมก็พบว่าช่วยทำให้ดีขึ้นในบางราย ไม่ใช่ทุกคน ดังนั้นยังไม่หมดหวังเสียเลยทีเดียว ต้องปฎิบัติตามคำแนะนำของหมอที่รักษานะครับเพราะรู้ดีที่สุด ต้องเชื่อใจท่านด้วยว่าท่านพยายามหาหนทางรักษาให้เราแล้วนะครับ  |
|
|
|
หัวข้อ 64: อุบัติเหตุ ทำให้เส้นประสาทตาขาด ครับ ช่วยที ทำอะไรได้บ้าง (กลุ้มใจมาก) (จำนวนคนอ่าน 15846 ครั้ง)
49.228.28.*
