Visual function in children with hemiplegia in the first years of life

The aim of this study was to evaluate the incidence of visual function abno rmalities in children with infantile hemiplegia, and the relation between v isual abnormalities and type of lesion, as shown by brain MRI, Visual funct ion was tested (grating acuity, visual field size, binocular optokinetic ny stagmus [OKN], and ocular movements) in a group of 47 children with congeni tal or early acquired hemiplegic cerebral palsy (mean age 25 months, range 8 to 52 months). The cohort was subdivided into four groups according to MR I findings: brain malformations (n=5), abnormalities of the periventricular white matter (n=20), cortical-subcortical lesions (n=16), and non-progress ive postnatal brain injuries (n=6). More than 80% of the children showed ab normal results in at least one visual test: acuity was the least impaired f unction, while visual field and OKN were abnormal in more than 50% of the c ohort. No specific correlation could be identified between the type and tim ing of the lesions and visual function. Unlike adults with stroke, visual h eld defects were not always related to contralateral damage in the optic ra diations or in the visual cortex. These results indicate that visual abnorm alities are common in children with hemiplegia, and that they cannot always be predicted by MRI, All children with hemiplegia need a detailed assessme nt of visual function.