Profile of Cerebral Visual Impairment in Children with Cerebral Palsy at a Tertiary Care Referral Center in Southern India

Introduction: Cerebral Visual Impairment (CVI) is a complex cognitive-perceptual dysfunction with wide spectrum of clinical manifestations. Perinatal insults like hypoxic ischaemic encephalopathy and neonatal hypoglycaemia are common aetiologies for neurological disorders like Cerebral Palsy (CP) and CVI. Currently there are no published data describing the features of CVI in CP from the Indian subcontinent. Aim: To describe the characteristics of CVI in children with CP at a tertiary care referral center in southern India. Materials and Methods: This was a cross-sectional study of children below the age of 18 years, referred to the CVI clinic of a tertiary care teaching hospital in southern India from March 2011Feb 2012. All children attending the clinic underwent a complete neuro-ophthalmology examination including functional vision assessment. They were classified into: 1) absent CVI; 2) probable CVI; and 3) definite CVI depending on the clinical examination. Results: A total of 341 children, M: F = 1.8: 1, age range 3 months17 years were included in the study. Around 69% (n = 236) of the referral had CP with 96% (n = 227) having spastic form of CP. Definite CVI was seen in 50% (n = 119) of children with CP. In children with CP and definite CVI history of neonatal and perinatal insults was more common and the most common clinical diagnosis was seizure disorder in 52% (n = 143) of children. Exotropia, temporal pallor of optic disc, inability to recognise face, impaired visual attention and lower field defect were the common clinical findings. Neuroimaging of children with CP and definite CVI showed occipital gliosis in 51% (n = 31) of cases. Conclusion: In our study, CVI was prevalent in children with CP. A detailed neuro-ophthalmological evaluation is a must in all children with special needs and it is important to be aware of the factors that contribute to CVI and initiate habilitative strategies early to improve their quality of life.