The Brain Injury Symptom My Doctors Didn't Understand

I had the pleasure of hearing Dr. Uzma Samadani speak at a Minnesota Brain Injury Alliance conference for professionals and was mesmerized by what she had to share regarding eye-tracking and the correlation to brain injury. I couldn’t soak up enough of what she had to share that day, so I was ecstatic to have the opportunity to interview her for an article, and you might say I was even a little star-struck.

You see — my eye-tracking was my biggest complaint that no one bothered to acknowledge.

Immediately after my fall that resulted in my traumatic brain injury (TBI), I knew my eyes weren’t quite right. In the beginning I wasn’t even able to read the words on my computer screen, like when I was trying to find the local ER. Time passed, and I kept telling every doctor I saw that something wasn’t quite right with my eyes.

Eventually I was sent to a neuro ophthalmologist who did extensive testing, only to tell me that my eyes were “fine.” I continued struggling with my vision and went to my eye doctor, who has known me for over 10 years. She tried everything to help me and concluded that I was seeing double, and my left eye was trying extra hard to keep me from seeing double, therefore causing strain on my eye.

It was the best answer I had been given thus far — yet I still didn’t feel it was good enough.

I was convinced my eyes were causing my dizziness and balance issues, and everyone blew me off by saying it was just positional vertigo. When I would go to sleep at night, I could feel my eyes start to move around on their own. However, I was dismissed over and over again, indicating that I was imagining it, and I was suffering from positional vertigo.

This is not what was affecting me!

At the two-and-a-half year mark Dr. Jeremy Schmoe, from Minnesota Functional Neurology DC in Minneapolis, reached out to me after reading one of my Huffington Postarticles. He told me he was confident he would be able to help me with my dizziness and balance issues.

I was skeptical at first because everyone else blew me off — and had never really listened to me.

I figured what did I have to lose, so I went in for a consultation. Dr. Schmoe spent two hours with me performing all sorts of tests. One of the very first tests he did was to run a red and white striped pattern past me, telling me to focus on only the white squares. The second he moved it, I had a dizzy spell and had to look away.

His response? “It’s your eyes — they’re not moving together properly.”

I wanted to cry, but this time it was happy tears instead of frustrated tears. Finally someone seemed to understand that my eyes indeed were causing me problems.

Dr. Schmoe explained, “You can sometimes evaluate eye movements, and the eye muscle and vision can look fine, but when the brain has to deal with a complex sensory environment, and the mechanisms to compensate have been injured, this can be a terrifying situation. In your case, there was involvement of all three systems (cervical, visual, and vestibular) which lead to sensory confusion or mismatch in the brain, causing these symptoms and changes in your autonomic system and emotionality.”

Now talking to Dr. Samadani, she considers it complete serendipity that she began the study of eye tracking. She had finished her residency and was conducting clinical trials for brain injury when a colleague suggested using eye-tracking as an outcome measure.

They began working on their technology, now known as EyeBOX™, in the summer of 2011 and applied for their first patent in 2012, which was issued in spring 2017. The study of elevated intracranial pressure (ICP) and reversible eye-tracking began in 2014 and was funded by a NASA affiliate organization interested in helping astronauts achieve prolonged space travel. Astronauts develop visual and cognitive problems while in space deployment — which mimics elevated intracranial pressure on earth — and they wanted to find a way to detect this.

Dr. Samadani explained that a concussion can disrupt eye movements in at least two ways: through elevating intracranial pressure, and by physiological disruption of neurologic pathways — not bad enough that pressure goes up, but it causes irritation.

In the study, a patient watches a music video on a computer screen that contains a square moving around the screen. As a patient follows the square, the device measures eye coordination. The device is attached to the computer so that a patient doesn’t have to wear it on his or her head.

When Dr. Samadani’s team developed their device, they wanted to make sure that a patient who wasn’t able to follow instructions would still be capable of using it. “Essentially we are testing brain stem function, which is done involuntarily — meaning you don’t have to think about it,” stated Samadani.

Historically, measuring the nerves that move the eye has been done by having a patient look in a direction (up, down, left, right), but that assumes a certain amount of function.

Eventually Dr. Samadani discovered that the equipment could ultimately detect differences in the left and right eye movements. The test does not need a baseline since 98.78 percent of people’s eyes move together.

The recent study looking at elevated ICP included 23 patients who required intracranial pressure monitoring for clinical reasons, including bleeding in the brain, while others were being monitored for pressure due to tumor or stroke. The study showed that nerve function in the brain decreased when pressure was elevated, and returned to normal when it came back down. The effect of elevated ICP on nerve function was detectable within minutes of ICP elevation.

Reviews by optometrists have shown that as many as 90 percent of people who seek attention for their concussion/brain injury have eye-tracking problems.

Dr. Samadani’s team hopes that this device will help patents receive the proper care right away. “We want someone who has suffered a traumatic brain injury to be diagnosed as quickly as possible so that they can be treated appropriately,” said Dr. Samadani.

She concluded by saying, “The majority of people who hit their heads don’t have a brain injury; however, we want to help identify those who need treatment.”

Dr. Uzma Samadani founded Oculogica in 2013, and her laboratory has developed the eye-tracking methodology and published six papers on its utility. She is currently the Rockswold Kaplan Endowed Chair for Traumatic Brain Injury at Hennepin County Medical Center and Associate Professor of Neurosurgery at the University of Minnesota. She serves on the American Association of Neurological Surgeons/Congress of Neurological Surgeons Executive Committee for Trauma and Critical Care and is Scientific Program Chair of the AANS/CNS National Neurotrauma Society Joint Satellite Meeting.

Read more by Amy Zellmer.
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Thinkstock photo by Wavebreak Media.