Visual field constriction in children with shunt-treated hydrocephalus

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Many ophthalmological abnormalities are described in conjunction with hydrocephalus. The results of visual field diagnosis remain a matter of further discussion. The aim of this study was to investigate visual field deficits in children with shunt-treated hydrocephalus.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>All children over 6 years of age treated for hydrocephalus at the authors' institute between December 2007 and December 2008 were included in the study. The children underwent an ophthalmological investigation for strabismus and binocular function, ophthalmoscopy, visual acuity, and refraction.</jats:p> <jats:p>The special focus was the visual field diagnosis, which the authors established in all children with cognitive conditions. The investigation was made by using the Goldmann visual field examination (kinetic perimetry). Children with and without visual field defects were compared concerning age at the time of ophthalmological examination, genesis of hydrocephalus, and frontooccipital horn ratio measured on current CT or MR images.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Complete investigations were undertaken in 56 children (24 girls and 32 boys, mean age 15.1 years). The following orthoptic pathological entities were diagnosed: 29 children have a strabismus in 29 cases, 17 of these have an exotropia, 12 an esotropia, 4 children a hypotropia, 2 a hypertropia and 3 children a heterophoria. A nystagmus was found in 10 children. The ocular fundus investigation showed 13 children with an optic nerve atrophy.</jats:p> <jats:p>A visual field diagnosis was possible in 44 of the 56 patients and was incomplete in 12 patients with cognitive deficits or inadequate compliance. In 24 of 42 children there was a concentric visual field constriction between 10° and 50° out of the center. Children with visual field deficits were older than those with a normal visual field (p = 0.051). Nine of 10 children with postmenigitic hydrocephalus had a visual field defect (p = 0.025). In children with visual field defects the frontooccipital horn ratio was significantly higher (p = 0.013).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The results suggest that children with shunt-treated hydrocephalus have a higher risk of having ophthalmological abnormalities. Visual field deficits are often a problem in these patients. A diagnostic visual field examination can complete the ophthalmological monitoring in patients with hydrocephalus, especially in patients with large ventricles. Children with postmeningitic hydrocephalus should be ophthalmologically monitored more frequently and intensively.</jats:p></jats:sec>

Cerebral Visual Impairment in Children

“…Expansion of the lateral ventricles into the temporal lobes can be associated with visual fi eld constriction (Rudolph et al 2010 ), impaired recognition and identifi cation, sometimes associated with topographic agnosia, while 'dorsal stream dysfunction' manifesting as impaired visual guidance of movement accompanied by impaired parallel processing ('simultaneous vision') is described by parents in over 50 % of cases of shunted hydrocephalus. It can lead to impaired visual acuities.…”

Imaging gene delivery in a mouse model of congenital neuronal ceroid lipofuscinosis

“…41,42,33 This approach is appealing for translation into humans since the neurosurgical procedure involved with ICV delivery of AAV vectors should be similar to placement of shunts in the lateral ventricles, a procedure carried out routinely in children to prevent hydrocephalus. 43 Intrathecal delivery of AAV vectors has also proven very efficient for global delivery of lysosomal enzymes to the CNS. 44 AAV vectors are by far the most widely used for gene delivery to the CNS in the experimental setting in the laboratory and also for clinical translation into humans as they mediate long-term gene expression (up to 96 weeks in humans) 45 with no apparent toxicity.…”

Spectral Domain-Optical Coherence Tomography As a New Diagnostic Marker for Idiopathic Normal Pressure Hydrocephalus

“…Thus, both elevated CSF pressure amplitudes in non-shunted iNPH patients as well as a sometimes decreased ICP in shunted iNPH patients could pathophysiologically cause distinctive glaucomatous changes of the LC and explain the heightened occurrence of glaucomatous changes in the studied group of iNPH patients. The elevated prevalence of glaucoma among iNPH patients (12) as well as the reported glaucomatous changes in visual fields of hydrocephalic children after CSF shunting (46) may support these hypotheses and further studies are needed to elucidate a possible relation.…”