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Paediatric patients with sudden vision impairment - An overview of MRI findings
Stephanie Lescher1, Valerie Wickmann1, Peter Hofstetter2
1Institute of Neuroradiology, Hospital of Goethe University, Frankfurt am Main, Germany.
Insights
Sudden vision loss in children requires urgent evaluation. Infectious diseases, migraine, and autoimmune conditions are common causes, with MRI aiding diagnosis, especially in young children.
Area of Science:
- Pediatric Ophthalmology
- Neuroradiology
- Pediatric Neurology
Background:
- Sudden visual impairment in children necessitates prompt recognition and management.
- Psychogenic disorders are a diagnosis of exclusion in school-aged children.
- Magnetic Resonance Imaging (MRI) is crucial for identifying optic pathway pathologies and serious intracranial conditions.
Purpose of the Study:
- To evaluate non-traumatic causes of acute vision impairment in children.
- To determine the utility of conventional cerebral and orbital MRI in diagnosing sudden visual impairment.
Main Methods:
- Retrospective analysis of MRI scans and clinical data.
- Study included 95 children (median age 12.5 years) with acute vision impairment.
Main Results:
- Acute visual impairment predominantly affects children over 7 years old.
- MRI findings correlated with clinical symptoms in 36% of cases.
- Common causes included infections (16%), migraine (12%), autoimmune diseases (11%), and neoplasms (8%).
Conclusions:
- Infectious diseases, migraine, autoimmune disorders, and tumors are frequent causes of acute vision loss in children.
- MRI is highly recommended for diagnosing acute vision impairment, particularly in children under 5 years old due to assessment difficulties.
Purpose:
Sudden visual impairment in children occurs sporadically but, when present, needs urgent attention. Optimal management strategies and timely recognition are required. Often psychogenic disorders are the cause in school-age children; however, this is a diagnosis of exclusion. Therefore, MRI plays an important role in ruling out pathology along the optic pathways or helping with the diagnosis of underlying life threatening diseases, such as hydrocephalus or intracranial mass. The purpose of this study was first to evaluate non-traumatic (tumoural and non-tumoural) causes of acute vision impairment; and, second, to assess whether conventional cerebral and orbital MR imaging is helpful for children with sudden visual impairment.
Patients And Methods:
We retrospectively analysed the MRI scans and clinical findings of 95 children (47 male, 48 female; median age: 12.5 years, range: from 2 to 17 years) who presented symptoms of monocular or bilateral acute vision impairment.
Results:
Patients with acute visual impairment were usually older than 7 years. In 36% of the patients a correlation between the MRI findings and the clinical symptoms was found. The most common causes of visual impairment were: infectious diseases (16%), migraine (12%), autoimmune diseases (11%), optic nerve neuritis with unknown aetiology (8%), neoplasms (8%), idiopathic intracranial hypertension (5%) and orthostatic hypotension (4%). Still, in 23% of the patients the cause remained unclear.
Conclusion:
Acute vision impairment is frequently caused by infectious diseases, migraine, autoimmune diseases or tumours in children. MRI is highly recommended, especially in the case of children younger than 5 years of whom clinical assessment can be difficult.
