Post-Traumatic Vision Changes and Perceptual Disturbances in a Young Female with History of Multiple Concussions

Case at a Glance

A 21-year-old female with a history of chronic rhinosinusitis and five previous concussions presents with new-onset binocular diplopia, reading difficulties, and episodes of depersonalization following a recent head trauma.

Patient's Story

The patient sustained a head injury two weeks prior when she accidentally collided heads with her partner while laughing. She has a significant history of five previous concussions and chronic rhinosinusitis requiring multiple surgical interventions. Two days post-injury, she began experiencing binocular diplopia, requiring monocular vision to watch television or read. She also experienced a concerning episode of depersonalization where she could not recognize her partner and felt an overwhelming need to distance herself from him, triggered by altered tactile perception. Subsequently, she developed progressive reading difficulties, unable to process text on road signs, restaurant menus, and television screens even with monocular vision.

Initial Assessment

The patient initially dismissed her symptoms as anxiety-related, hoping they would resolve spontaneously. She was reluctant to seek medical attention due to recent extensive medical treatments for chronic sinus infections. Friends encouraged her to seek evaluation when her vision problems became apparent to others.

The Diagnostic Journey

Progressive symptoms over two weeks included: binocular diplopia requiring monocular compensation, inability to read text at various distances, difficulty focusing while driving, and one episode of depersonalization. Notably, symptoms occurred without accompanying headaches and appeared randomly throughout the day. The patient also reported baseline vertigo but denied dizziness during symptomatic episodes.

Final Diagnosis

Post-concussion syndrome with binocular vision dysfunction and possible convergence insufficiency. The perceptual disturbances and depersonalization episode were consistent with post-traumatic neurological changes affecting visual processing and spatial awareness.

Treatment Plan

Comprehensive neurological evaluation including detailed vision assessment by neuro-ophthalmology. Cognitive rest protocols implemented. Referral for specialized concussion management given her history of multiple head injuries. Vision therapy consultation recommended for binocular dysfunction rehabilitation.

Outcome and Follow-up

Patient education provided regarding the serious nature of her symptoms and the importance of medical evaluation despite her reluctance. Close monitoring planned for symptom progression, with particular attention to any worsening of cognitive or visual symptoms that might indicate more severe traumatic brain injury.