Werth Reinhard
Institute for Social Pediatrics and Adolescent Medicine, University of Munich, Heiglhofstr. 63, D-81377 München, Germany.
Restor Neurol Neurosci. 2008;26(4-5):377-89.
This paper explores whether the child's visual system is more or less vulnerable than the adult's visual system, whether the capacity of the child's visual system to recover from cerebral blindness exceeds the capacity of the adult's, and which brain structures can mediate visual functions after damage to the geniculostriate visual system. Reports about the development of visual functions in normal and in visually-deprived children and about the recovery of visual functions after incomplete damage to the occipital lobe, unilateral hemispherectomy, and in the absence of both cerebral hemispheres in early life, are reviewed. In addition, 2 new cases are reported. A child (patient 1) is described, who was blindfolded, but had normal visual experience for 2 hours daily between the 24 and the 30 months of age. Despite the daily visual experience, there was an elevation of the luminance difference threshold (LDT) in the periphery of the visual field. An adult patient (patient 2) showed a special mode of "blindsight" that may be present in brain damaged children but that cannot be tested in young children. This patient was always able to detect targets correctly only by "feeling" their presence without actually seeing them. After damage to the geniculostriate system, lost visual functions reappeared in more than half of the children during visual-field training. In many children, the enlargement of the visual field exceeded the enlargement that was reported in hemianopic adults during visual-field training. In rare cases, visual targets were reliably detected in both visual hemifields, even after hemispherectomy.
本文探讨儿童视觉系统相较于成人视觉系统是更易受损还是更具耐受性,儿童视觉系统从脑性失明恢复的能力是否超过成人,以及在膝状纹状体视觉系统受损后哪些脑结构能够介导视觉功能。本文回顾了关于正常儿童和视觉剥夺儿童视觉功能发育的报告,以及枕叶不完全损伤、单侧半球切除术后和早年双侧大脑半球缺失后视觉功能恢复的报告。此外,还报告了2例新病例。描述了一名儿童(患者1),其在24至30个月大时每天被蒙眼2小时,但有正常的视觉体验。尽管有日常视觉体验,其视野周边的亮度差异阈值(LDT)仍有所升高。一名成年患者(患者2)表现出一种特殊的“盲视”模式,这种模式可能存在于脑损伤儿童中,但无法在幼儿中进行测试。该患者总是只能通过“感觉”目标的存在而不是实际看到它们来正确检测目标。在膝状纹状体系统受损后,超过一半的儿童在视野训练期间恢复了丧失的视觉功能。在许多儿童中,视野扩大超过了视野训练期间偏盲成人报告的扩大程度。在极少数情况下,即使在半球切除术后,两个视觉半野也能可靠地检测到视觉目标。