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[Primary exotropia: importance of cerebral MRI]
C Baeteman1, D Denis, C Loudot
1Service d'Ophtalmologie pédiatrique et générale, Hôpital Nord, Marseille. christophebaet@aol.com
Insights
Cerebral MRI is crucial for diagnosing infantile exotropia, with abnormal results increasing with deviation severity. This highlights the importance of pathological context and ophthalmological findings in infantile exotropia.
Area of Science:
- Ophthalmology
- Pediatric Neurology
- Neuroradiology
Context:
- Infantile exotropia, a common strabismus in early childhood, can be associated with underlying neurological conditions.
- Cerebral imaging is essential for accurate diagnosis and prognosis in cases of infantile exotropia.
Purpose:
- To evaluate the sensorimotor status and analyze cerebral MRI findings in infants diagnosed with primary exotropia.
- To correlate the degree of exotropic deviation with the presence and type of cerebral abnormalities detected via MRI.
Summary:
- A study of 47 infants with primary exotropia revealed a high incidence of abnormal cerebral MRIs (72.3%), with white matter (61.8%) and gray matter (41.2%) injuries being most common.
- Pathological MRI findings were significantly more frequent in cases with larger degrees of eye deviation.
- Associated ophthalmological abnormalities and a pathological perinatal context were prevalent in the majority of infantile exotropia cases.
Impact:
- Cerebral MRI plays a fundamental role in the diagnostic workup of infantile exotropia, aiding in the identification of associated neurological conditions.
- Understanding the link between exotropia severity and MRI abnormalities can refine diagnostic and prognostic assessments.
- This research underscores the necessity of a comprehensive evaluation, including neuroimaging, for infants presenting with exotropia.
Introduction:
Primary exotropia is a divergent strabismus that appears from the first day of life to the second year. It can be isolated or associated with a pathological context requiring cerebral imaging to determine diagnosis and prognosis. The objective of this study was to report the sensorimotor state and the result of MRI in infantile exotropia.
Patients And Method:
Forty-seven children with primary exotropia had a complete ophthalmologic assessment (visual acuity, binocular vision, refraction with cycloplegia, eye fundus) and cerebral MRI (average age, 16 months). Deviation was classified into four categories<4 degrees, > or =4<10 degrees, > or =10<20 degrees, > or =20 degrees. MRI results were classified into seven categories: white matter abnormalities (gliosis, delay of maturation, periventricular leukomalacia, aspecific hyperintense signal, and necroses); Virchow-Robin enlargement space and enlarged subarachnoid space; gray matter abnormalities (necroses, cerebral atrophy, occipital cortex, basal ganglia); ventriculomegaly; thin corpus callosum; cerebellar injury; and tumor.
Results:
There was a statistically significant increase in the rate of pathological MRI as the angle deviation increased: 76.6% of patients had a pathological ophthalmologic exam (amblyopia, ptosis, head posture, Duane's syndrome, cataract, albinism, or pigmentary retinopathy). We found 38% nystagmus and 38% optic nerve hypoplasia. There was a real pathological context in 61.7% of the exotropia cases: 27.7% prematurity, 31.9% fetal distress, 21.3% facial dysmorphy (plagiocephaly), 12.8% psychomotor delay, and 14.9% epilepsy. Only three children had isolated exotropia. Thirty-four cerebral MRI (72.3%) were not normal. In pathological MRI, there was 61.8% white matter injury, 41.2% gray matter injury, and 17.6% thin corpus callosum.
Conclusion:
This study demonstrates the fundamental contribution of cerebral MRI in infantile exotropia. The greater the deviation, the more abnormal the MRI results are. The pathological context and ophthalmological abnormalities are important in infantile exotropia.
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