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Sjoukje E Loudon, Jeroen Dudink, Liesbeth Smit, Jan Roelof Polling, Huibert Jan Simonsz; The role of MRI in infants with strabismus and central nervous system disorders. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2436.
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© 2017 Association for Research in Vision and Ophthalmology.
The proportion of Infantile Esotropia (IE) associated with Central Nervous System Disorders (CNSD) is increasing. In this study we investigated the role of MRI in infants with CNSD and IE.
Since March 2012 all infants with perinatal incidents resulting in damage to the central nervous system who visited the out-patient clinic of pediatric neurology and presented with a strabismus (Bruckner test), are being referred to the department of Ophthalmology. They received full orthoptic and ophthalmological examination. The neurological documentation included classification of cerebral palsy: spastic, dyskinetic or atactic. In addition, the GMFCS (Gross Motor Function Classification System) scale ranging from 1 (mild impairment in functional abilities) to 5 (impaired in all levels of motor function) was recorded. All children had a post-natal MRI brain scan. All scans were performed using a 1.5-T GE Echo Speed scanner (General Electronics Medical Systems, Milwaukee, Wisconsin, USA) according to a standard imaging protocol. MRI’s were assessed (JD) using a simplified scoring system: 1. Unilateral or bilateral brain injury 2.Presence of white matter injury (0=none, 1=mild-moderate, 3= severe) and 3. Presence of (cortical or deep) grey matter injury (0=none, 1=mild-moderate, 3= severe).
So far, 35 children with a CNSD and strabismus have been referred by the pediatric neurologist, mean age at examination was 9.5 months (range 4-18 months). Thirteen (37%) of the referred children were diagnosed with IE. All of them had severe bilateral white matter lesions periventricular; which had resulted in spastic cerebral palsy, and their GMFCS ranged from 1-5. The remaining 22 children had various types of strabismus ranging from exotropia, to microstrabismus. Their MRI scans showed various types of lesions, but the periventricular white matter area was spared. They had cerebral palsy spastic or dyskinetic. Their GMFCS ranged from 1-5.
Remarkably all infants with CNSD resulting in spastic cerebral palsy and IE showed similar bilateral periventricular white matter injury, which included posterior fibers of the optic radiation. A subsequent study will be done to determine if, based on the MRI lesion, a more extensive scoring system (assessing all substructures of the brain: including basal ganglia, thalami, mesencephalon, cerebellum and all white matter tracts) can accurately predict the risk of IE.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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