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Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
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Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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meaning of box carss retina sign after head injury

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meaning of box carss retina sign after head injury

Please, if you would, could you provide me more information about the head injury and the events surrounding this sign.


Did an ophthalmologist tell you about this sign?

Customer: replied 6 years ago.
8 year old child struck by wild backswing of golf club swung by 9 year old larger child. Immediate unconsciousness and cessation of respiration. Immediate medical first aid, CPR and ambulance within 10 minutes to nearby hospital ER but in and out of ventriucular fibrillation and failure to recover respiration in 4 hours at hospital while on life support. Box cars evident on opthalmic exam and EEG is flat bit heart is beating. Decision pending whether to terminate support or to maintain respirator and for how long. Any ideas from your experience are welcome.

The "box-carrimng" of the retinal blood vessels is an indicator of a significant impediment to and/or arrest of blood flow within the retina and in this instance is indicative of the larger process of impaired blood flow in the head in general.


As an ophthalmic surgeon, unfortunately, my experiences with traumatic brain injuries and prognoses for recovery in these cases is limited. The circumstances surrounding this trauma, including a flat EEG and failure to breathe on his own, I think, are likely poor prognostic indicators and speak to what is likely to be a poor outcome. Beyond that, however, I wouldn't have any recommendations that would carry significant clinical weight because of my lack of expertise in this area.


If this is your relative I am truly sorry for this unspeakable event. Please know that my heart and prayers go out to you and this boy's family.


I hope this helps in some small way.


I am happy to be able to help you today. If you would be so kind, please help me get credit for my efforts in answering your questions and press the ACCEPT button for this encounter. I will also be happy to answer any other questions until you have the information you need.


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My opinion is solely informative and does not constitute an informed medical opinion or recommendation. For an informed medical opinion and/or recommendation you must see an eye doctor.

Customer: replied 6 years ago.
Does the box car sign affect prognosis regarding possible loss of vision (blindness) in case of survival?

The box car sign itself does not affect the actual prognosis regarding vision loss in case of survival. It is a sign that the retina, like other parts of the head, has had an impediment in blood flow. This can mean, however, that there can be damage to the eye/retina just as there can likely be brain damage from this entire event. In that context, yes, this could be a harbinger of possible vision loss. But, unfortunately, it is not a predictive sign as other signs in medicine may be.


Does that make sense?

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