Cerebral visual impairment in preterm infants with periventricular leukomalacia

doi:10.1016/S0887-8994(97)00152-5

Pediatric Neurology

Volume 17, Issue 4, November 1997, Pages 331-338

https://doi.org/10.1016/S0887-8994(97)00152-5 Get rights and content

Abstract

Neonatal brain lesions are the main cause of cerebral visual impairment in infancy, i.e., of a visual deficit caused by damage to posterior visual pathways. Visual outcome of preterm infants with periventricular leukomalacia (PVL) was investigated in 14 subjects affected by severe cystic PVL, another 34 with moderate PVL (prolonged periventricular echodensities), and 18 control preterm infants. All cases with significant ocular abnormalities (such as retinopathy of prematurity state III or upwards, optic nerve atrophy, or major refraction problems) were excluded. Visual acuity, visual field, eye alignment, fixation and following, optokinetic nystagmus, and visual threat were tested at 1 year of corrected age. A high incidence of cerebral visual impairment, consisting mainly of low visual acuity, severe oculomotor disorders, and reduced visual field, was found in infants with severe PVL. Visual defects were less frequent and less severe in the moderate PVL group, and very rare in the control group. The results of neuroimaging, and especially of magnetic resonance imaging, correlated with the visual outcome and indicate lesions at the level of optic radiations as the main anatomic substrate of the visual impairment. All infants with PVL need a visual follow-up, from the first months of life, the results of which are important both for visual and motor rehabilitation of these cases and for their daily care.

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Cited by (126)

Visual impairment and periventricular leukomalacia in children: A systematic review
2023, Research in Developmental Disabilities
Thanks to Magnetic Resonance Imaging (MRI) it is now possible to diagnose lesions of the central nervous system (CNS) such as periventricular leukomalacia (PVL) from the first days of life. However, there are still few studies aimed at describing the relationship between MRI and the outcome of visual function in patients with PVL.
To systematically review and investigate the relationship between MRI neuroimaging and visual impairment arising from PVL.
Three electronic databases (PubMed, SCOPUS, Web of Science) were consulted from 15 June 2021–30 September 2021. Of the 81 records identified, 10 were selected for the systematic review. The STROBE Checklist was used to assess the quality of the observational studies.
PVL on MRI was found to have a strong association with visual impairment in the various aspects of visual function (visual acuity, ocular motility, visual field); in 60% of these articles, the selected subjects also reported damage to optical radiations.
there is a clear need for more extensive and detailed studies on the correlation between PVL and visual impairment, in order to set up a personalized early therapeutic-rehabilitation plan.
Over the past decades numerous studies have reported increasing evidence that one of the most frequent sequelae in subjects with PVL, in addition to motor impairment, is the impairment of visual function even if it is still not clear what different authors mean with the term visual impairment.
This systematic review presents an overview of the relationship between structural correlates of MRI and visual impairment in children with periventricular leukomalacia. Interesting correlations emerge between MRI radiological finding and consequences on visual function especially between damage to the periventricular white matter and the impairment of various aspects of visual function and also between the impairment of optical radiation and visual acuity. Thanks to this literature revision, it is now clear that MRI plays an important role in the screening and diagnosis of significant intracranial brain changes in very young children in particular about the outcome of visual function. This is of great relevance since that visual function represents one of the main adaptive functions in the development of the child.
Brain microstructural antecedents of visual difficulties in infants born very preterm
2022, NeuroImage: Clinical
Citation Excerpt :
Along with alterations found in the optic radiations, we observed diminished FD, FC, and FDC of tracts across the dorsal and ventral streams, suggesting that both pathways may be impacted. Deficits in dorsal and ventral visual stream processing have also been observed in preterm children with PVL and cerebral palsy, further indicating a widespread atypical processing in higher-order visual impairments (Cioni et al., 1997; Fazzi et al., 2004, 2007). ROP is a disease characterized by abnormal growth of vasculature due to altered oxygen concentrations and blood flow in preterm birth.
Infants born very preterm (VPT) are at risk of later visual problems. Although neonatal screening can identify ophthalmologic abnormalities, subtle perinatal brain injury and/or delayed brain maturation may be significant contributors to complex visual-behavioral problems. Our aim was to assess the micro and macrostructural antecedents of early visual-behavioral difficulties in VPT infants by using diffusion MRI (dMRI) at term-equivalent age.
We prospectively recruited a cohort of 262 VPT infants (≤32 weeks gestational age [GA]) from five neonatal intensive care units. We obtained structural and diffusion MRI at term-equivalent age and administered the Preverbal Visual Assessment (PreViAs) questionnaire to parents at 3–4 months corrected age. We used constrained spherical deconvolution to reconstruct nine white matter tracts of the visual pathways with high reliability and performed fixel-based analysis to derive fiber density (FD), fiber-bundle cross-section (FC), and combined fiber density and cross-section (FDC). In multiple logistic regression analyses, we related these tract metrics to visual-behavioral function.
Of 262 infants, 191 had both high-quality dMRI and completed PreViAs, constituting the final cohort: mean (SD) GA was 29.3 (2.4) weeks, 90 (47.1%) were males, and postmenstrual age (PMA) at MRI was 42.8 (1.3) weeks. FD and FC of several tracts were altered in infants with (N = 59) versus those without retinopathy of prematurity (N = 132). FDC of the left posterior thalamic radiations (PTR), left inferior longitudinal fasciculus (ILF), right superior longitudinal fasciculus (SLF), and left inferior fronto-occipital fasciculus (IFOF) were significantly associated with visual attention scores, prior to adjusting for confounders. After adjustment for PMA at MRI, GA, severe retinopathy of prematurity, and total brain volume, FDC of the left PTR, left ILF, and left IFOF remained significantly associated with visual attention.
Early visual-behavioral difficulties in VPT infants are preceded by micro and macrostructural abnormalities in several major visual pathways at term-equivalent age.
Advances in the evaluation and management of cortical/cerebral visual impairment in children
2020, Survey of Ophthalmology
Cortical/cerebral visual impairment (CVI) is the most frequent cause of pediatric visual impairment in developed countries and is increasing in prevalence in developing nations. The most common underlying etiology is hypoxic-ischemic encephalopathy, particularly in premature children. Other causes include seizures, hydrocephalus, trauma, and infections. Because of neurologic comorbidities, children with CVI often present challenges in diagnosis and characterization of visual deficits. Caregiver questionnaires may aid in assessment of visual functioning, while newer types of neuroimaging, including functional neuroimaging and diffusion tensor magnetic resonance imaging, may provide further insights on structure-function relationships. Genetic testing may assist in identification of underlying genetic or metabolic syndromes. Although no standard therapy for pediatric CVI exists, advances in care of preterm children and those with hypoxic-ischemic encephalopathy may in future reduce the incidence of this disorder. In addition, various methods of visual stimulation and stem cells have been advocated as treatment for pediatric CVI. Future controlled trials using standardized methods of visual assessment are necessary to establish whether these interventions are superior to observation. Practitioners should work with families and teachers of children with CVI to optimize their environment for visual functioning. Comorbid ocular and systemic disorders, which are common, should be managed appropriately.
Alterations in the Structural and Functional Connectivity of the Visuomotor Network of Children With Periventricular Leukomalacia
2019, Seminars in Pediatric Neurology
Children born preterm with periventricular leukomalacia (PVL) demonstrate increased difficulties with tasks requiring visuomotor integration. The visuomotor integration network encompasses brain regions within frontal, parietal, and occipital cortices. Because of their proximity to the lateral ventricle the underlying white matter pathways are at a high risk of damage following PVL-related hypoxic-ischemic white matter injury. This study provides an exploratory analysis of the structural and functional connections within the visuomotor integration network, along with an a priori evaluation of the superior longitudinal fasciculus, inferior fronto-occipital fasciculus, and frontal aslant tract. For each pathway, tracts within both hemispheres revealed decreased volume and number of reconstructed fibers and an increase in quantitative anisotropy and generalized fractional anisotropy. The connectivity results also indicate that there may be changes to both the structural integrity and functional integration of neural networks involved with visuomotor integration functions in children with PVL.
Supramodal agnosia for oblique mirror orientation in patients with periventricular leukomalacia
2018, Cortex
Citation Excerpt :
Depending on the size and location of the PVL necrosis, a wide spectrum of clinical symptoms can be observed, from severe visual impairment, combined with cerebral palsy and mental retardation to mild visuo-motor impairments and normal intelligence (for a review see: Jacobson & Dutton, 2000). Previous studies have described visual-perceptual impairment in these subjects, such as restriction of visual field, deficit in crowding, visual integration (identification of whole figures from incomplete visual information), object recognition and motion perception (Cioni et al., 1997; Fazzi et al., 2004; Guzzetta et al., 2009; Jacobson, Ek, Fernell, Flodmark, & Broberger, 1996; Morrone et al., 2008; Stiers, De Cock, & Vandenbussche, 1998). Here we show that few of these children can also have mirror orientation agnosia that can greatly impact on their everyday life.
Periventricular leukomalacia (PVL) is characterized by focal necrosis at the level of the periventricular white matter, often observed in preterm infants. PVL is frequently associated with motor impairment and with visual deficits affecting primary stages of visual processes as well as higher visual cognitive abilities. Here we describe six PVL subjects, with normal verbal IQ, showing orientation perception deficits in both the haptic and visual domains. Subjects were asked to compare the orientation of two stimuli presented simultaneously or sequentially, using both a two alternative forced choice (2AFC) orientation-discrimination and a matching procedure. Visual stimuli were oriented gratings or bars or collinear short lines embedded within a random pattern. Haptic stimuli comprised two rotatable wooden sticks. PVL patients performed at chance in discriminating the oblique orientation, both for visual and haptic stimuli. Moreover when asked to reproduce the oblique orientation, they often oriented the stimulus along the symmetric mirror orientation. The deficit generalized to stimuli varying in many low level features, was invariant for spatiotopic object orientation, and also occurred for sequential presentations. The deficit was specific to oblique orientations, and not for horizontal or vertical stimuli. These findings show that PVL can affect a specific network involved with the supramodal perception of mirror symmetry orientation.
Retrochiasmal Disorders
2018, Liu, Volpe, and Galetta's Neuro-Ophthalmology: Diagnosis and Management
The retrochiasmal afferent visual pathways include the optic tract, lateral geniculate nucleus, optic radiations, and striate cortex. The most common neuro-ophthalmic presentation of a unilateral retrochiasmal disturbance is a homonymous hemianopic field defect with normal acuity.
Important concepts in retrochiasmal disorders will be discussed first. The second part of this chapter will be subdivided by localization and progress from anterior to posterior structures, with neuroanatomy, clinical presentation, and common etiologies described in each section. The last portion of this chapter details the diagnosis and management of lesions in the optic radiations and occipital lobe. Emphasis will be placed on cerebrovascular disease, since it is among the most common causes of retrochiasmal disorders.

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: This work was supported by grant RC 2/95 of the Italian Ministry of Health.

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Original articleCerebral visual impairment in preterm infants with periventricular leukomalacia

Abstract

Behav Brain Res

Behav Brain Res

Brain Dev

Behav Brain Res

Brain Dev

Early Hum Dev

Brain injury in the premature infant—Current concepts of pathogenesis and prevention

Biol Neonate

Visual recovery from hypoxic cortical blindness during childhood. Computed tomographic and magnetic resonance imaging predictors

Arch Ophthalmol

Correlation between cerebral visual impairment and MR imaging in children with neonatal encephalopathy

Dev Med Child Neurol

Visual assessment during the first years of life

Visual and neurological outcome of infants with periventricular leukomalacia

Dev Med Child Neurol

Early predictors of cerebral visual impairment in infants with cystic leukomalacia

Neuropediatrics

Visual impairment in preterm children with periventricular leukomalacia—Visual, cognitive and neuropaediatric characteristics related to cerebral imaging

Dev Med Child Neurol

Relation between neonatal cranial ultrasound abnormalities and cerebral visual impairment in infancy

Dev Med Child Neurol

Ophthalmic findings in infants of very low birthweight

Dev Med Child Neurol

The acuity card procedure: A rapid test of infant acuity

Invest Ophthal Vis Sci

Acuity assessment of non-verbal infants and children: Clinical experience with the acuity card procedure

Dev Med Child Neurol

Original article
Cerebral visual impairment in preterm infants with periventricular leukomalacia