Cortical visual impairment — branching viva

Opening question

Examiner: Take me through this child. What is the diagnosis, and what is the clue that points you to it? ^[1]

Candidate: The most likely diagnosis is cortical visual impairment. The key clue is that the child sees poorly despite a structurally normal eye — clear media, normal red reflex and healthy retina. The extreme prematurity and spastic diplegia point to periventricular leukomalacia, and the paradoxical behaviours, turning toward the light while ignoring near faces, fit the CVI pattern. My frame is to confirm the eye is normal, confirm the brain cause with imaging, characterise the functional vision with structured assessment, and then build a habilitative plan. ^{[1] [2]}

Examiner: Why has the term moved from cortical blindness to cerebral visual impairment? ^[1]

Candidate: Because the older term is misleading in three ways. First, most of these children are not blind — they have usable vision that fluctuates. Second, the injury is often not confined to the cortex; it involves the optic radiations and posterior white matter as well. Third, the problem is not just basic acuity but higher-order perception. Cerebral visual impairment is the preferred umbrella term because it captures the retrogeniculate pathway injury and the spectrum from basic to perceptual deficits. ^{[1] [2]}