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Early predictors of cerebral visual impairment in infants with cystic leukomalacia
P Eken1, L S de Vries, O van Nieuwenhuizen
1Department of Child Neurology, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
Insights
Extensive cystic leukomalacia on neonatal ultrasound strongly predicts cerebral visual impairment (CVI) in infants. Early identification using acuity card procedures can diagnose CVI in high-risk newborns.
Area of Science:
- Neonatal neurology
- Pediatric ophthalmology
- Neuroimaging
Background:
- Neonatal cranial ultrasound (US) can identify brain lesions.
- Cerebral visual impairment (CVI) in infants may result from neurological insults.
- Cystic leukomalacia is a significant neonatal brain injury.
Abstract:
A longitudinal prospective follow-up study looking at the correlation between haemorrhagic-ischaemic lesions on neonatal cranial ultrasound (US) and the development of cerebral visual impairment (CVI) in infancy resulted in the detection of nine infants with severe visual impairment, which was not due to opthalmological abnormalities. Extensive cystic leukomalacia proved to be highly predictive of CVI, as well as of severe mental and motor deficit in these nine infants. The present report outlines the results of different examinations (acuity card procedure [ACP], visual evoked potential [VEPs], magnetic resonance imaging [MRI]) performed during the first 18 months, to find out which combination of examinations would be the most predictive of CVI at an early stage. The results indicated that infants with a gestational age of 35 weeks or more, who sustained extensive cystic leukomalacia during the neonatal period, and were subsequently not fixating at the acuity cards at term and at three months of age, invariably developed CVI. VEPs were also severely abnormal in the infants with the worst visual outcome, but were not providing a more reliable prognosis. Also, a good correlation between MRI-abnormalities of the optic radiations and/or the visual cortex and CVI was found, but MRI was usually performed beyond the age of 12 months.