Naslov
Cerebral visual impairment in the child with periventricular leukomalacia - case report

Autori
Mejaški Bošnjak, Vlatka ; Alimović, Sonja ; Čokolić Petrović, Dunja ; Bošnjak, Jelena ; Đaković, Ivana ; Milaščević, Darko ; Vulin, Katarina

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
The 6th Croatian neuroscience congress with international participation, Book of abstracts, Osijek, Croatia, September 16-18, 2017 / - , 2017

Skup
The 6th Croatian neuroscience congress with international participation

Mjesto i datum
Osijek, Hrvatska, 16.09.2017. - 18.09.2017

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
cerebral visual impairment, child, periventricular leukomalacia

Sažetak
Introduction: Cerebral visual impairment (CVI) is the most common cause of permanent visual impairment in children, yet often goes unrecognized. The diagnosis of CVI is indicated for children showing abnormal visual responses that cannot be attributed to eyes themselves. Brain dysfunction must explain the abnormal visual responses. Visual spatial disturbances: localization of objects, judgment of direction and distance of objects and orienting the body in relation to the physical world are associated with posterior parietal(-occipital) lobe lesions i.e. due to the „dorsal“ visual association pathway. Visual perceptual disturbances: discrimination, recognition and integration of visual images and objects are associated with inferior posterior lobe lesions i.e. „ventral“ visual pathway. Common causes CVI in infants and young children include: hypoxic ischemic encephalopathy ( in the term born infant), periventricular leukomalacia (PVL - in the preterm infant), traumatic brain injury, neonatal hypoglycemia, infections, metabolic disorders, CNS developmental defects . Accompanying features of CVI include cerebral palsy and developmental delays. Confusing diagnostic entities include: delayed visual maturation, autism spectrum disorders, profound mental retardation, epilepsy, particularly West syndrome. We present symptoms of CVI in the girl aged 12 years, with cerebral palsy and periventricular leukomalacia. Presented patient is third born child from mother suffering diabetes mellitus type I. Delivered by SC due to perinatal asphyxia, oxygenated. BW 3700g, BL 51cm, Apgar 9/10, gestation weeks 38 +5, cushingoid, immature, pale, hypotonic, brain ultrasound revealed periventricular leukomalacia grade 3. which was confirmed by brain MRI at age of 4 years. Motor development delayed, at 3y started to walk without support, few steps, falling frequently. At age of 3y suffered epilepsy, s put on antiepileptic drugs. Neurological examination last performed at age of 12 y: walks independently, with flexion in hips and knees, able to walk on toes, walking on heels difficult, can’t walk in line, increased muscle tone, more of the lower extremities, marked asymmetry, limited dorsiflexion of left foot, hyperreflection of right patellar tendon, other normal. Atethosis of both hands, coordination imprecise, limitations in fine motor skills. Ophthalmological examination: strabismus, wears glasses pale optic disc, sciascopy +1, 5 both, ERG-normal, VEP-damaged neural conductivity on both sides. Psychological assessment: at age 12 y (MVPT, WISC-IV) overcomes individualized school curriculum, with personal assistant. She has short attention span, the difficulty of spatial, visual and auditory integration. Difficulties of visual focusing and visual perception are dominant. i.e. objects discrimination, differentiation figures from background, visual memory, difficulties in complex spatial relations. Intellectual capacities uneven, the best in verbal skills, and memories. Surveillance Cerebral Palsy in Europe classification: Bilateral spastic CP, due to PVL, functional grading: motor development (GMFCS 2, BFMF 2b), vision impaired, hearing normal, epilepsy stabilized by antiepileptic drugs. Conclusion: the child with CVI has frequently co-existing neurodevelopmental disorders which often becomes the focus of input and educational support. If CVI is unrecognized or its impact ignored potential for habilitation may be lost. This is a missed opportunity to provide an individualized, structured program of support which may make a huge difference to outcomes for the child.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA