Cerebral Visual

Impairment
 Definition of Cortical Blindness and Visual
Impairment Congenital and
Acquired
• Blindness or Visual Impairment (CVI) due to
bilateral damage to the occipital cortex (Hoyt,
2003).
• The absence or reduction of vision in either
eye while still maintaining a normal pupillary
response to light and a normal ocular
examination.
• It can occur both congenitally and it can be
acquired, with many fewer cases acquired.
 Congenital CVI Diagnosis and
Evaluation

• Diagnosis of exclusion and based on history

information.
• Perinatal hypoxia/ischemia, Traumatic Brain
Injury (TBI), encephalitis and meningitis.
• About 75% have accompanying neurological
deficits in a recent study.
 Common Causes
of CVI in Children

• Hypoxic Ischemic Encephalopathy (HIE) term

infant
• Periventricular Leukomalacia (PVL) pre-term
infant
• TBI– shaken baby, accidental head injuries,
meningitis, shunt failure, severe seizures,
cardiac arrest, CNS developmental delays
 Congenital CVI
Common Signs and Symptoms
• Vision appears variable, even hour to hour
• Children with CVI may be able to use their peripheral
vision more efficiently than their central vision.
• One third are photophobic, others are light gazers.
• Color vision is generally preserved.
• The vision of children with CVI has been described as
“looking through a piece of Swiss cheese”.
• May exhibit poor depth perception, influencing their
ability to reach for a target.
• Vision may be better when either the visual target or
the child is moving.
 Congenital CVI
Common Signs and Symptoms

• Blunted or avoidant social gaze

• Brief fixations, intermittent following
• Reduced visual acuity
• Visual field loss - generalized constriction,
inferior altitudinal, hemianopic defect
• Reduced responses to visual stimuli when
music, voices, and other sounds are present,
and often, when the child is touched
 Dorsal Visual Systems
disrupted with CVI
Dorsal “where is it pathway” associated with posterior
parietal (occipital) lobe lesions cause

• Visual motor disturbances

– deficits in fixing direct visual attention to an object
– shifting fixation and gaze to new stimulus
– fine motor tasks such as copying and drawing

• Visual Spatial disturbances

– localization of objects
– judgment of direction and distance objects
– orienting the body to the physical world
 Ventral Visual Systems
disrupted with CVI

• Ventral “what is it” aspect of vision – inferior

temporal lobe lesions
– Discrimination
– Recognition
– Integration of visual images and objects
 Causes of Adult Cortical Visual
Impairment
• Cerebrovascular Accidents (CVA)– 700,000 per
year in the US
– The largest group of visual disorders after acquired
brain injury are homonymous hemianopsia (HVFD).
Approximately 20-30% of all patients with CVA
requiring treatment in a rehabilitation center have
HVFD.
– It should be noted that 40% of HVFD recover after stroke,
especially within 2 months of the stroke
• Traumatic Brain Injury - 85,000 people suffer long term
disabilities
– In the U.S., more than 5.3 million people live with
disabilities caused by TBI
 Acquired CVI
Diagnosis and Evaluation

• MRI/CAT scan would indicate location of

damage which would lead to diagnosis of CVI
• Varied levels of improvement of visual field
and visual acuity after sometimes total loss of
vision with CVA or TBI
 Acquired CVI
Common Symptoms

• Most common vision loss is hemianopsia

• Less common is bilateral occipital loss with
near or total blindness
• Usually no strabismus or other ocular disorder
• Anton Syndrome – the patient may deny the
vision loss entirely, may be aware of color
• Patients may be able to navigate the
environment despite serious vision loss
“Blindsight”
 Rare Disorders with Cortical Visual
impairment
– Balint’s syndrome – paralysis of gaze with haphazard
scanning. Damage to the posterior parietal cortex.
Damage to the posterior superior watershed areas or
parietal-occipital vascular border zone or temporal-
occipital damage.
• Optic Ataxia – incoordination of hand and eye movement
• Oculomotor Apraxia -the inability to voluntarily guide eye
movements/ change to a new location of visual fixation
• Simultanagnosia - the inability to perceive more than one
object at a time, even when in the same place
Treatment includes compensatory strategies
 Rare Disorders with Cortical Visual
Impairment
– Blindsight –
• Type 1 patient has no awareness of any stimuli, but can report
accurately location or movement of an object.
• Type 2 – when subjects have some awareness of movement within the blind
field, but not able to report what the object is.

– Hemispatial Neglect – also called hemineglect, spatial

neglect or neglect syndrome
• Damage to the parieto -occipital area of typically right side of brain
• Deficit in attention to and awareness of one side of space

– Alien hand syndrome – the hand has “a mind of its own”

• Caused by lesion of corpus callosum, could be secondary to
surgery for epilepsy
 Tips for work with CVI

• Control visual input to avoid over stimulation

• Eliminate extraneous noise or visual distractions
from environment
• Present one item at a time
• Touch should be used to cue
• Use language to label objects and describe
objects
• Movement may assist child or adult to “find”
objects (i.e. allow them to move or rock, bring
food into mouth of child in an arc when feeding)
THANK YOU