Cerebral Visual Impairment in Periventricular Leukomalacia*

Abstract

Infants with cerebral palsy (CP) frequently present cerebral visual impairment (CVI) often caused by damage to retrochiasmatic pathways. This is particularly true of subjects with damage to the periventricular white matter. Thirty-eight preterm infants with periventricular leukomalacia (PVL) diagnosed by MRI were examined to correlate binocular visual acuity with neuroradiological findings. Binocular visual acuity was evaluated using Teller Acuity Cards and a complete ophthalmological examination was also performed. Three infants with ROP III were excluded from the sample. The age of observation ranged from 20 months to 5 and a half years (mean 42 months). The possible involvement of the optic radiations and/or of the calcarine cortex was detected by brain MRI. Twenty-three infants (66%) presented visual impairment. Of these, 9 (26%) were totally or nearly totally blind and 14 (40%) were low vision children. The other 12 (34%) had normal (2) or near normal (9) vision. MRI findings correlated with visual acuity; a relationship was detected between the degree of visual acuity and the reduction of the peritrigonal white matter, and also between the degree of visual acuity and the extent of calcarine atrophy. This report clearly establishes a relationship between visual impairment and specific MRI findings in children with PVL. Teller Acuity Cards and MRI are useful for detecting potential visual impairment and for improving both the clinical diagnosis of these disorders and the therapeutic approach to these subjects.

Systemic 7,8-Dihydroxyflavone Treatment Protects Immature Retinas Against Hypoxic-Ischemic Injury via Müller Glia Regeneration and MAPK/ERK Activation

“…1 Specifically, the prevalence of visual impairments, such as strabismus, ocular motor apraxia, nystagmus, optic atrophy, restriction of the visual field, 2,3 defective color vision, 4,5 and reduced grating acuity 4,5 range from 66% to 94% in these children. 6,7 The treatment and long-term care of the affected children consist of a huge burden and cost to the family, professionals, and society. The above-mentioned visual impairments in those brain-damaged infants have been mainly attributed to occipital lesions in the brain.…”

Subnormal visual perception in school-aged ex-preterm patients in a paediatric eye clinic

“…24,25 . Lanzi et al 26 found a correlation between reduction of VA and reduction of the peritrigonal white matter as well as the extent of calcarine atrophy. Reduction of the volume of the peritrigonal white matter on MRI has been reported to correlate with impairment of visual perception in children with spastic diplegia.…”

The Apparently Blind Infant

“…76 The territorial distributions and neurologic consequences of perinatal retrogeniculate injury reflect the developing brain's level of maturity at the time of injury (Table 1.1). 34,37,38,91,144,174,265,280,281,349,599 In the full-term infant, the brain receives its vascular supply primarily from the major cerebral arteries, and its watershed areas lie at the interfaces between the major cerebral arterial distributions. 35,174,599 Mild degrees of term hypoxic-ischemic injury produce watershed infarctions in the arterial border zones (i.e., the parieto-occipital and parasagittal cortex), injuring both gray and white matter, usually resulting in encephalomalacia.…”

“…36,99,265,281 Neuroimaging abnormalities in these children are frequently confined to subcortical white matter (optic radiations and corticospinal tracts) as opposed to the cortical gray matter injury that predominates in term anoxia. 32,35,36,144,174,265,280,281,341,349,599 Preterm injury to the developing brain that primarily injures subcortical white matter produces PVL. 76 PVL is usually seen in ventilator-dependent premature infants who survive longer than a few days.…”

“…PVL is an important cause of cerebral palsy (mainly spastic diplegia), intellectual impairment, and visual impairment. 41,42,46,48,82,83,89,280,349,448,449,587 Some children with PVL are neurologically normal and function within the normal range at detailed neuropsychological and cognitive testing. 23,494,618 However, even premature infants with normal neurologic outcomes have a high incidence of neurocognitive impairment.…”