Childhood blindness

Introduction Cortical blindness is a central visual dysfunction caused by toxins or vasospasm in the occipital cortex of the brain, with vasospasm being the most common. The clinical manifestations are complete loss of binocular vision, normal pupillary light reflex, normal fundus, and hemiplegia. The disease is common in children 2 to 6 years old. Modern western medicine generally uses corticosteroids and vasodilator drugs, but the efficacy is not satisfactory. Cortical blindness is equivalent to pediatric blue-blind in Chinese medicine. Chinese medicine believes that it is related to lack of congenital endowment, liver and kidney loss.

Cause

A common cause of cortical blindness is cerebrovascular disease. About 50% of cortical visual impairment is caused by focal or occlusive cerebrovascular disease, and it is rare in encephalitis, brain tumor, brain trauma, hypoxia, degeneration, and demyelinating disease. It can also be one of the complications of carbon monoxide poisoning, post-seizure, cerebral angiography and migraine.

an examination

Related inspection

CT examination of the eyes and sacral area CT examination of ophthalmoscopy

(1) The vision is completely lost and the light is lost.

(2) Loss of eyelid closure reflex when strong light is applied or when a finger suddenly reaches the front of the eye.

(3) The presence of light reflection and convergence reflection.

(4) The structure of the retina is normal, and the fundus is not seen in the fundus.

(5) may be associated with hemiplegia, partial sensory disturbance, aphasia, loss of recognition, memory and disorientation.

(6) Electroencephalogram Closed eye reaction disappeared, and optometry nystagmus did not respond.

(7) Flash ERG (retinal current map) is normal, but visual cortical evoked potential VEP is abnormal.

Differential diagnosis

Cortical blinds are differentiated from the following symptoms.

1. Blindness, blindness

(1) Cortical blindness often has various primary diseases that can cause cortical blindness, such as cerebrovascular disease and trauma. A rickety blindness often has a history of trauma. The swindler has a certain psychological motivation.

(2) Cortical blindness is often accompanied by other organic symptoms, while rickets are blind and deceived often have other neurological symptoms, and there are many changes.

(3) Sudden eyebrows with strong beams or glare with sharp objects. Cortical blindness has no blinking reflexes and avoidance responses, while blistering blindness and fraud often have blink reflexes and avoidance reactions.

(4) Cortical blind suggestion or psychotherapy is ineffective, and sputum blind suggestion or psychotherapy is effective.

(5) There may be no visual nystagmus in cortical blindness, and visual nystagmus is present in rickets and blistering.

(6) Electrophysiological examination (mainly visual cortical evoked potential VEP): abnormal cortical blind VEP examination, and VEP examination of rickets blind and deceptive is normal. Blind, deceptive EEG, closed eye reaction exists.

2. Eye diseases

Various eye diseases can also cause vision loss in both eyes, including cornea, retina, lens, vitreous and optic neuropathy, such as keratitis, retinal hemorrhage, cataract, optic neuritis and other diseases. Identification with cortical blindness has the following characteristics.

(1) After the monocular vision disorder, the other eye is involved.

(2) The degree of vision loss is different, and both eyes are lost at the same time.

(3) There are many other characteristics of eye diseases: such as tearing, fear of light and other symptoms.

(4) An abnormality can be found in an eye examination.

(5) Vision can be improved after removing the cause.

(6) The head CT is mostly normal.

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