Cognitive visual dysfunctions in preterm children with periventricular leukomalacia.
OBJECTIVE
Cognitive visual dysfunctions (CVDs) reflect an impairment of the capacity to process visual information. The question of whether CVDs might be classifiable according to the nature and distribution of the underlying brain damage is an intriguing one in child neuropsychology.


METHODS
We studied 22 children born preterm (12 males, 10 females; mean age at examination 8y, range 6-15y; mean gestational age 30wks, range 28-36wks) with periventricular leukomalacia, spastic diplegia, normal intelligence (mean Full-scale IQ 84; mean Verbal IQ 97; mean Performance IQ 74), and normal visual acuity, focusing on higher visual functions. Brain magnetic resonance images (MRI) were analysed to establish the presence of lesions along the primary optic pathway, in the occipitoparietal and occipitotemporal regions.


RESULTS
Most children displayed an uneven cognitive profile, with deficits in visual object recognition, visual imagery, visual-spatial skills, and visual memory, and sparing of visual associative abilities, non-verbal intelligence, and face and letter recognition. Conventional brain MRI did not document major alterations of parietal and temporal white matter, or cortical alteration of areas involved in visual associative functions.


CONCLUSIONS
We suggest a widespread involvement of higher visual processing systems, involving both the ventral and dorsal streams, in preterm children with periventricular leukomalacia. The lack of major alterations on conventional MRI does not exclude the possibility of malfunctioning of higher visual processing systems, expressing itself through discrete CVDs. Possible mechanisms underlying these neuropsychological deficits are discussed.
Centre of Child Neurophthalmology, Department of Child Neurology and Psychiatry, IRCCS 'C Mondino Institute of Neurology' Foundation, Pavia, Italy.
Elisa
E
Fazzi
Stefania
S
Bova
Alessia
A
Giovenzana
Sabrina
S
Signorini
Carla
C
Uggetti
Paolo
P
Bianchi
D000293:Adolescent; D002547:Cerebral Palsy / Q000150:complications* / Q000473:pathology; D002648:Child; D002657:Child Development; D003072:Cognition Disorders / Q000209:etiology* / Q000473:pathology; D003210:Concept Formation; D002658:Developmental Disabilities / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007969:Leukomalacia, Periventricular / Q000150:complications* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D010468:Perceptual Disorders / Q000209:etiology* / Q000473:pathology; D014786:Vision Disorders / Q000209:etiology* / Q000473:pathology; D014795:Visual Pathways / Q000473:pathology; D014796:Visual Perception