In patients with cerebral palsy (CP), cerebral visual impairment (CVI) is frequently found in addition to ophthalmological disorders. Lesions in the visual areas are found in CT scans of CP patients with CVI. The aim of the present study was to determine the prevalence of these specific findings in CP patients with CVI. CT scans of 49 cerebral palsy patients were studied; CVI was diagnosed in 36 patients; in 13 patients, visual acuity was normal. In 8 patients, comparison with an MRI scan was possible (6 with CVI, 2 with normal acuity). The CT scans were scored according to the criteria used by Van Nieuwenhuizen (1987): normal, abnormalities of the white matter adjacent to the posterior horns of the lateral ventricles, abnormalities of the white matter located under the visual cortex, abnormalities of the visual cortex and abnormalities elsewhere. Abnormalities in the visual areas were found in 15% of the normal acuity group and in 53% of the CVI group. In 17 of the 19 CVI patients with abnormalities in the visual areas, the lesions were located in the white matter surrounding the posterior horns (89%). MRI imaging revealed the same abnormalities as the CT scans in 6 patients, but in one patient the abnormality was seen in more detail and in one patient the lesion in the occipital area was seen only on MRI. MRI examination seems to detect at least as many, but in some cases even more specific lesions in CVI patients compared to CT scanning, but the numbers were too small to allow any definitive conclusions to be drawn.

SUMMARY Assessment of visual acuity using the visual acuity card procedure in 164 children with cerebral palsy revealed low visual acuity in 71 per cent. Results of ophthalmological examination were available for 74 of these patients, but could not explain adequately the low visual acuity of 36 of the 43 patients (84 per cent) assessed by both the acuity card procedure and other techniques. There is a high probability that cerebral visual disturbance is present in these patients. Awareness of visual disability when compiling a programme of visual and neurodevelopmental stimulation for children with cerebral palsy is essential. RÉSUMÉ La prévalence des troubles centraux de la vision dans l'IMC L'appréciation de l'acuité visuelle à partir de tableux d'acuité visuelle chez 164 sujets IMC a révélé une acuité visuelle basse dans 71 pour cent des cas. Les résultats des examerts ophtalmologiques étaient disponibles chez 74 sujets mais ne pouvaient expliquer l'acuité visuelle basse de 36 des 43 sujets (84 pour cent) évalués à la fois par les tableaux d'acuité visuelle et d'autres techniques. Il y a une haute probabilité qu'il existait un trouble visuel central chez ces sujets. La reconnaissance d'un déficit visuel en établissant un programme de stimulation visuelle et neurodéveloppementale chez les IMC est essentielle. ZUSAMMENFASSUNG Die Häufigkeit der cerebralen Sehstörung bei Cerebralparese Die Beurteilung der Sehschärfe mit dem Acuity Card Verfahren bei 164 Patienten mit Cerebralpares zeigte bei 71 Prozent eine verminderte Sehschärfe. Von 74 dieser Patienten waren die Ergebnisse der augenärztlichen Untersuchung verfügbar, sie konnten aber bei 36 der 43 Patienten (84 Prozent), die sowohl mit dem Acuity Card Verfahren als auch mit anderen Methoden untersucht wurden waren, die verminderte Sehschärfe nicht hinreichend erklären. Wenn man ein Programm zur visuellen und entwicklungsneurologischen Stimulation für Kinder mit Cerebralparese zusammenstellt, ist es sehr wichtig auf das Vorliegen einer Sehstöbrung zu achten. RESUMEN Prevalencia de la alteración visual cerebral en la parálisis cerebral La evaluación de la agudeza visual utilizando el procedimiento de las tarjetas de agudeza visual en 164 pacientes con parálisis cerebral reveló una agudeza visual baja en el 71 por ciento de los casos. En 74 des estos pacientes se pudo obtener un examenoftalmológico, pero ello no pudo explicar adecuadamente la disminución visual de 36 de los 43 pacientes (84 por ciento) evaluados al mismo tiempo con las cartas de agudeza y con otros técnicas. Existe una alta probabilidad de que en estos casos la alteración visual sea de origen cerebral. Es esencial el darse cuenta de la presencia de la alteración visual cuando se crea un programa de estimulación visual y neuroevolutiva en niños con parálisis cerebral.

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A group of 43 patients suffering from cerebral palsy and cerebral visual impairment was compared with a group of 24 cerebral palsy patients with normal visual acuity, with regard to a functional level in daily life. Four categories were considered: communication, emotional contact, self-care and intelligence. Cerebral visual impairment-cerebral palsy patients scored significantly lower in all categories than cerebral palsy patients with normal visual acuity. In the cerebral visual impairment-cerebral palsy group, there was a higher frequency of tetraplegia compared with the group with normal acuity, but even after this predominance had been excluded, a significant difference remained. When dealing with cerebral palsy patients, occurrence of cerebral visual impairment must be taken into account. By initiating intervention programmes, one can prevent extra handicaps due to the consequences of diminished visual acuity.