Original article Visual – perceptual impairment in children with periventricular leukomalacia Elisa Fazzi a, * , Stefania Maria Bova a , Carla Uggetti c , Sabrina Giovanna Signorini a , Paolo Emilio Bianchi b , Ilaria Maraucci a , Marina Zoppello a , Giovanni Lanzi a a Department of Child Neuropsychiatry, IRCSS C. Mondino Foundation, via Ferrata, 6, 27100 Pavia, Italy b Department of Ophthalmology, IRCSS S. Matteo Hospital, University of Pavia, Pavia, Italy c Department of Radiology, IRCSS C. Mondino Foundation, University of Pavia, Pavia, Italy Received 4 August 2003; received in revised form 30 January 2004; accepted 3 February 2004 Abstract We set out to define visuo-perceptual impairment related to periventricular leukomalacia (PVL) using the Developmental Test of Visual Perception (DTVP). Correlations were sought between visual–perceptual deficits and DTVP profile and neuroradiological and neurophthalmological findings. The DTVP was administered to 20 children (m/f: 10/10), aged between 5 and 8 years (mean: 6.95 years), presenting with: spastic diplegia; PVL documented by brain MRI; normal or mildly impaired visual acuity; mild-moderate upper limb functional impairment. The mean General Visual – Perceptual Quotient was impaired, showing a great variability among the patients. Despite this, an uneven DTPV profile, characterised by a significant difference between the VMIQ and the Non-Motor Visual – Perceptual Quotient ðP , 0:001Þ; and a poor result on the Closure subtest (identification of whole figures from incomplete visual information) was observed in all the subjects. This profile reflects a deficit in eye – hand coordination and in praxic-constructional abilities and could be the expression of malfunctioning of the occipital – parietal pathway of visual integration, the so-called ‘dorsal stream,’ a hypothesis reinforced by the emergence of a statistically significant correlation between the neuroradiological data and the presence of visual – perceptual impairment. q 2004 Elsevier B.V. All rights reserved. Keywords: Visual– perceptual impairment; Periventricular leukomalacia; Spastic diplegia 1. Introduction Visual function is crucial for development and can be impaired by several conditions, particularly prematurity. Prematurity is, in fact, well known to give rise both to ophthalmological disorders (e.g. strabismus, refractive errors, retinopathy) and to cerebral visual impairment (CVI) due to brain damage (mainly periventricular leuko- malacia, PVL). A main reason for this association between prematurity and CVI is the contiguity between the site of PVL and the optic radiations. Cerebral damage in premature infants can also involve other visual pathway structures (e.g. lateral geniculate body, calcarine cortex and visual associative areas) and gives rise to various disorders, ranging from reduced visual acuity/visual field and oculomotor incoordination to complex visuo-cognitive disorders (‘visual perceptual impairment (VPI)’). The term CVI covers all these disorders. It is worth noting that premature subjects with CVI tend to present an associated motor deficit, usually spastic diplegia (SD). Of the various manifestations of CVI, VPI emerges as one of the most frequent in PVL subjects. The term VPI refers to disturbances of higher visual abilities caused more by malfunctioning of the associative visual systems than by posterior visual pathway damage. The pathogenesis of VPI is still not fully understood: Abercrombie [1] considered it to be caused by motor handicap and strabismus, a hypothesis rejected by many other authors [2–7], who maintain that visual impairment and ocular motility dysfunctions are not the direct cause of VPI, even though they are frequently present in affected subjects. Brain & Development 26 (2004) 506–512 www.elsevier.com/locate/braindev 0387-7604/$ - see front matter q 2004 Elsevier B.V. All rights reserved. doi:10.1016/j.braindev.2004.02.002 * Corresponding author. Tel.: þ 39-382-380280; fax: þ 39-382-380286. E-mail address: efazzi@unipv.it (E. Fazzi).