Neuro-ophthalmological disorders in cerebral palsy: ophthalmological, oculomotor, and visual aspects.
OBJECTIVE
Cerebral visual impairment (CVI) is a disorder caused by damage to the retrogeniculate visual pathways. Cerebral palsy (CP) and CVI share a common origin: 60 to 70% of children with CP also have CVI. We set out to describe visual dysfunction in children with CP. A further aim was to establish whether different types of CP are associated with different patterns of visual involvement.


METHODS
A total of 129 patients (54 females, 75 males; mean age 4 y 6 mo, SD 3 y 5 mo; range 3 mo-15 y) with CP (51 with diplegia, 61 with tetraplegia, and 17 with hemiplegia; 62 [48%] of participants were able to walk) and CVI enrolled at the Centre of Child Neuro-ophthalmology (at the Department of Child Neurology and Psychiatry, IRCCS 'C. Mondino Institute of Neurology', University of Pavia) underwent an assessment protocol including neurological examination, developmental and/or cognitive assessment, neuro-ophthalmological evaluation including ophthalmological assessment, evaluation of visual acuity, contrast sensitivity, optokinetic nystagmus, visual field and stereopsis, and neuroradiological investigations.


RESULTS
Visual dysfunction in diplegia was characterized mainly by refractive errors (75% of patients), strabismus (90%), abnormal saccadic movements (86%), and reduced visual acuity (82%). The participants with hemiplegia showed strabismus (71%) and refractive errors (88%); oculomotor involvement was less frequent (59%). This group had the largest percentage of patients with altered visual field (64%). Children with tetraplegia showed a severe neuro-ophthalmological profile, characterized by ocular abnormalities (98%), oculomotor dysfunction (100%), and reduced visual acuity (98%).


CONCLUSIONS
Neuro-ophthalmological disorders are one of the main symptoms in CP. Each clinical type of CP is associated with a distinct neuro-ophthalmological profile. Early and careful neuro-ophthalmological assessment of children with CP is essential for an accurate diagnosis and for personalized rehabilitation.
Child Neurology and Psychiatry Unit, Mother-Child Department, Civil Hospital, University of Brescia, Brescia, Italy. elisa.fazzi@gmail.com
Elisa
E
Fazzi
Sabrina G
SG
Signorini
Roberta
R
LA Piana
Chiara
C
Bertone
Walter
W
Misefari
Jessica
J
Galli
Umberto
U
Balottin
Paolo Emilio
PE
Bianchi
D000293:Adolescent; D002547:Cerebral Palsy / Q000145:classification / Q000150:complications / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D015835:Ocular Motility Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D014786:Vision Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*