However, the visual dysfunction relevant to the present review is that of the pupillary light reflex (PLR). More specifically, it may produce a constellation of visual problems of a sensory (e.g., reduced contrast sensitivity, visual field deficits), motor (e.g., vergence dysfunction, saccadic dysmetria) and/or perceptual (e.g., impaired distance perception, difficulty with figure–ground discrimination) nature. For example, there may be problems with impulse control, sleep, attention and memory, to name a few. In addition, this pervasive brain injury results in a constellation of general medical problems of a sensory, motor, perceptual, cognitive, attentional, physical, physiological and/or behavioral nature. This is especially the case for the white matter tracts, which become stretched/deformed and at times broken leading to neural signal processing errors, distortions and delays. The resultant injury to the brain and surrounding microenvironment, frequently being of a coup–contrecoup nature, produces widespread neural damage. There are approximately 1.8 million mTBIs in the USA annually, primarily from motor vehicle accidents, falls and sports/recreational accidents, with perhaps up to 10 million worldwide. This was primarily as a result of the USA’s recent military encounters in Iraq and Afghanistan, where TBI was the ‘signature injury’ and frequently the ‘invisible injury’, as well as from the sports arena, in particular football with its potential link to chronic traumatic encephalopathy. The area of mTBI has been in the forefront of the medical world for more than a decade. The pupil may also be a window to mild traumatic brain injury (mTBI). Some believe that the pupil is the window to the soul.
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