From the Research
Magnetic Resonance Imaging (MRI) is the recommended imaging modality for post-concussion patients experiencing visual disturbances. When a patient presents with persistent visual symptoms following a concussion, an MRI with contrast should be performed to evaluate for structural abnormalities that may be causing these symptoms. MRI is preferred over Computed Tomography (CT) in this context because it provides superior visualization of brain tissue, white matter tracts, and subtle abnormalities that might affect the visual pathways, as noted in a study published in 2018 1. The imaging should focus on the occipital lobe, optic nerves, optic chiasm, and visual cortex to identify any lesions, microhemorrhages, or areas of inflammation that could be contributing to visual disturbances.
In cases where there is concern for vascular injury, MR angiography (MRA) may be added to the protocol. Timing is important - imaging should be obtained promptly if symptoms are severe, progressive, or accompanied by other neurological deficits, but may be deferred for 1-2 weeks in stable patients to allow for potential resolution of temporary post-concussive changes. This approach helps clinicians distinguish between transient post-concussive visual symptoms and those caused by structural abnormalities requiring specific intervention. A recent study in 2022 2 highlights the importance of early screening for visual disturbances in TBI patients, which further supports the use of MRI as a diagnostic tool in this context. Additionally, advanced neuroimaging techniques, such as those discussed in a 2019 study 3, may provide further insights into the underlying pathophysiology of post-concussive visual disturbances, but MRI remains the primary recommended imaging modality.
Key considerations in the imaging protocol include:
- Focusing on the occipital lobe, optic nerves, optic chiasm, and visual cortex
- Using MRI with contrast to evaluate for structural abnormalities
- Considering MR angiography (MRA) if there is concern for vascular injury
- Timing of imaging, with prompt evaluation for severe or progressive symptoms and potential deferral for 1-2 weeks in stable patients. The use of MRI in this context is supported by studies such as those published in 2016 4 and 2018 1, which highlight the importance of advanced imaging in the diagnosis and management of post-concussive symptoms.