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Q and A: Can a Blow to the Head Render My Character Blind?

01 Jul

Q: My male character hits his head on a wall, rendering him blind. How long would he be blinded for, once the swelling that caused it goes down? Any long term effects, such as headaches and that?

Michelle Cunin, Alliance, Ohio

A: Blunt trauma to the head if it is severe enough to cause a cerebral contusion (brain bruise), where by definition there is some degree of bleeding into and swelling of the brain tissues as a result of the trauma, can easily cause a malfunction in that area of the brain. If it is the area of the brain that controls vision, your victim could easily have blindness. We call this cortical blindness since it arises from the cortex of the brain and not from the eye or from the optic nerve. In other words the loss of the ability to see comes from the brain itself. The visual cortex, the part of the brain that controls seeing, is in the very back of the brain in what we call the occipital lobe. In order for your victim to be completely blind both halves of the brain would have to be damaged otherwise he would only lose vision to his right side or his left side but not both. But this could easily happen with a blow to the back of the head or can occur after a fall where the back of the head strikes a wall, the floor, stairs, or almost anything else.

 

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If the injury were severe enough to significantly damage the optical cortex then his blindness could be permanent but in most cases once the bleeding inside the brain stops and the swelling resolves, vision will return. This could take a few hours or many weeks so you have a broad range to consider when constructing your story. Any of these are possible.

The victim’s blindness might be complete or only partial in that he might be able to see shadows and shapes or one half of his visual field might be clearer than the other. This later situation would indicate that one side of the brain was damaged more severely than the other. If it were the left occipital lobe that was more severely damaged then the right half of his visual field would be the most affected. If he were struck in the left back side of the head, for example, he could lose vision of the entire right side of his visual field. It would appear as if a line had been drawn down the center of his visual field and everything to the right of the line would be black while to the left all would be normal. But since you want him completely blind it would require injuries to both occipital lobes.

Whether his vision returns or not, he could suffer from long-term headaches, dizziness, poor balance, and a few other symptoms but he could also return to complete normalcy. These symptoms could last a few days, months, or forever. All is possible.

 

 

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25 Comments

Posted by on July 1, 2013 in Medical Issues, Q&A, Trauma

 

25 responses to “Q and A: Can a Blow to the Head Render My Character Blind?

  1. Fritz Strobl MD

    July 1, 2013 at 9:20 am

    Doug: Nice diagram and great explanation! I’ve seen it in closed head injuries as a contrecoup injury from frontal trauma, but normally the patient would have a lot of pre-frontal damage as well. Not necessarily a bad story line as it would also cloud his decision making.

    We bought your “Royal Pains” book, nice job.

    Fritz

     
    • D.P. Lyle, MD

      July 1, 2013 at 9:22 am

      Thanks, Fritz. It was a fun question. Hope you like the Royal Pains books.

      Are you coming to ThrillerFest next week?

       
      • Fritz Strobl MD

        July 1, 2013 at 10:14 am

        Yes. Bringing Debi who signed up for everything. Coming in Tuesday night. Kimberley asked me to help with security muscle, which I will. Looking forward to seeing you! Missed you since last year!

         
      • D.P. Lyle, MD

        July 1, 2013 at 10:28 am

        Great. See you there.

         
  2. Fritz Strobl MD

    July 1, 2013 at 9:21 am

    But the occipital trauma is probably the easiest. Fritz

     
  3. Fritz Strobl MD

    July 1, 2013 at 10:16 am

    Doug, here might be a fun topic. http://en.wikipedia.org/wiki/B%C3%A1lint's_syndrome
    Balint’s Syndrome.

     
    • D.P. Lyle, MD

      July 1, 2013 at 10:29 am

      Very cool. Never heard of this one. You brain guys are so smart. We heart guys are just plumbers.

       
      • Fritz Strobl MD

        July 1, 2013 at 10:41 am

        Since we don’t get to do the neat stuff you do, we have to think up syndromes that are unique.

         
      • D.P. Lyle, MD

        July 1, 2013 at 10:56 am

        Like this one.

         
  4. A. Michael Schwarz

    July 1, 2013 at 11:40 am

    You’ve always got hysterical blindness as a last resort.

     
  5. Elaine Goss

    July 1, 2013 at 12:17 pm

    A blow to the head can cause detached retinas in those who are very nearsighted.

     
    • D.P. Lyle, MD

      July 1, 2013 at 12:22 pm

      Near or far sighted has little to do with retinal detachments and they are only rarely bilateral. But this could easily lead to blindness or impaired vision in one eye.

       
  6. Susanne Alleyn

    July 1, 2013 at 2:31 pm

    This actually happened in my family — to a cat. She was (apparently) struck a glancing blow by a car, not visibly hurt, no marks, no wounds, no broken bones, but knocked unconscious. When she came to, she was at least partially blind. Poor thing walked around in tight circles, stumbling into things, for weeks. Gradually, after three or four months, she recovered. It was like watching a newborn kitten mature all over again, re-learning how to eat kibble, use the box, etc. She ended up completely healthy and apparently able to see normally.

     
  7. Cheryl B. Dale

    July 1, 2013 at 3:28 pm

    Your blog is always interesting and informative!

     
  8. Christine Kling

    July 2, 2013 at 4:51 am

    Doug – Great timing! I’d just figured out that a continuing character of mine was going to lose his eyesight in a fight. I wanted to go with cortical blindness because it means the undamaged eyes will still react to light and look “normal.” But I wanted him to only be partially blind because I wanted to include some neat tech in the way of assistive technologies, but I wasn’t sure whether cortical blindness was all or nothing. You’ve described it well – how he can be “legally blind” but still retain some vision. Thanks!

     
    • D.P. Lyle, MD

      July 2, 2013 at 7:55 am

      Christine–timing is everything. Glad it worked out and good luck with your story.

       
  9. marilynm

    July 2, 2013 at 5:48 am

    My son was severely beaten, hit in the head with bar stools and a table at Christmas time while working as a bouncer. (No one was arrested.) and he received brain trauma, his vision worsened enough he now wears glasses, he still has problems with his memory, balance, etc. Now when I see people in movies getting hit on the head with heavy objects and getting right up and fighting back it makes me wonder.

     
    • D.P. Lyle, MD

      July 2, 2013 at 7:56 am

      Hollywood has no relationship with reality.

       
  10. Fritz Strobl MD

    July 2, 2013 at 8:47 am

    Doug – Looks like it was a great topic!

    Fritz

     
  11. jenniferklewis

    August 4, 2013 at 8:17 pm

    Can I jump in here too. I also want my character to be blind, but aesthetically fine, and I was wondering if blindness can be caused by radiant heat from a severe house fire? She jumps from a burning building with her baby sister in her arms, so the damage could be due to the fall, but I’m very keen on the fire being the cause.

    Your help would be much appreciated.

     
    • D.P. Lyle, MD

      August 5, 2013 at 6:02 am

      Trauma would still be your best bet but if the fire was intense it could damage her corneas, scaring them. This could reduce her vision to only shadows and vague light, lacking in detail. But for this to happen she would have to suffer at least some fire damage to her face. This could be first and second degree so there would be no residual scarring or she could have areas of third degree burning which would scar. Her vision could be repaired with a corneal transplant so this defect would not be permanent.

       
      • jenniferklewis

        August 5, 2013 at 8:55 am

        Perfect. Thanks so much for that. Cheers

         
  12. drshaywest

    January 2, 2014 at 5:15 pm

    This info will definitely help with my story line too :D I still can’t decide if I want my villain to lose his sight via an occipital blow or trauma to his eyes and face… *decisions decisions* ;)

     

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