Visual Impairment in Cerebral Palsy

Aim: Cerebral Visual Impairment (CVI) is actually considered a main symptom of clinical picture of Cerebral Palsy (CP), as stated by classification of CP (Rosenbaum P. et al., 2005) CP and CVI share a common origin; 60-70% of children with CP also have CVI. We set out to describe visual dysfunction, expression of CVI, in children with CP with the aim to improve diagnostic accuracy and to plan specific rehabilitation tools. Methods: 70 CP (13 with diplegia, 30 with tetraplegia and 27 with hemiplegia) were recruited at Unit of Child Neurology and Psychiatry of Brescia in the period 2010-2012 (30 girls and 40 boys; age range 1-11 yrs, mean age 4 yrs) underwent a tailored neuro-ophthalmological evaluation (including ophthalmological assessment, evaluation of visual acuity, contrast sensitivity, optokinetic nystagmus, visual field and stereopsis) associated to the clinical assessment including neurological examination, developmental and/or cognitive assessment, and neuroimaging. Results: Visual involvement in subjects with diplegia is characterised mainly by strabismus, abnormal saccadic movements, reduced visual acuity (mild/moderate) and refractive errors, present in at least 75% of cases. Visual profile in subjects with hemiplegia is similar but less severe than diplegic ones, peculiarly characterized by alterations of visual field. Children with tetraplegia show a severe involvement of all neuro-ophthalmological functions where the main symptom is a reduced visual acuity (moderate/severe) present in all cases. Conclusion: Neuro-ophthalmological disorders are a main symptom in CP. Each clinical type of CP is associated with a distinct neuro-ophthalmological profile. Early and careful neuro-ophthalmological assessment of children with CP is essential for an accurate diagnosis and for personalised rehabilitation tools