title: Unsuspected periventricular leukomalacia in children with strabismus: a case series.
abstract: OBJECTIVE
  We report a case series of seven patients who presented with strabismus and no apparent known neurological deficit.
  
  
  METHODS
  A retrospective review of notes was performed on all patients presenting at the Royal Liverpool Children's Hospital (Alder Hey) with strabismus, in whom subsequent investigation revealed the presence of periventricular leukomalacia (PVL).
  
  
  RESULTS
  All seven patients presented with esotropia. One patient also had dissociated vertical deviation. A history of premature birth was elicited in six cases; however, one patient had been born at 42 weeks. Apparently uncomplicated routine surgery produced unexpectedly poor results.
  
  
  CONCLUSIONS
  Patients with undiagnosed PVL may present to the ophthalmologist with strabismus and no other apparent neurological abnormality. Where it is suspected that the patient may have suffered a significant hypoxic-ischaemic event, the ophthalmologist should have a low threshold for investigating with magnetic resonance imaging, particularly if the patient shows unexpected outcomes following appropriate treatment. Patients and parents should be counselled on possible suboptimal results prior to the offer of surgical correction of strabismus.
authors: Department of Paediatric Ophthalmology, Royal Liverpool Children's Hospital (Alder Hey), Liverpool, UK.
authors: Wisam J
authors: WJ
authors: Muen
authors: Muhammad U
authors: MU
authors: Saeed
authors: Musa
authors: M
authors: Kaleem
authors: Laurence
authors: L
authors: Abernethy
authors: Arvind
authors: A
authors: Chandna
mesh_terms: D001921:Brain / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D004948:Esotropia / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007969:Leukomalacia, Periventricular / Q000150:complications* / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies