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September 16, 2025Open Access

Indications of Brain Magnetic Resonance Imaging in Pediatric and Adolescent Patients with Non-Traumatic Visual Disturbance

KLKi‐Bum LeeIncheon National University GJGwon Hui Jo SLSarah LeeRadboud University Nijmegen

Key Points

Positive brain MRI findings occurred in 12.7% of pediatric patients with visual disturbances, indicating the need for MRI evaluation.
The presence of relative afferent pupillary defect, pale disc, and reduced retinal nerve fiber layer thickness were significantly associated with positive MRI results.
Among patients with positive findings, brain tumors were diagnosed in half, emphasizing the importance of thorough ophthalmologic assessments.
This analysis involved retrospective medical record review of 63 patients under 18 years experiencing non-traumatic visual disturbances.

Abstract

Purpose: We investigated the ophthalmologic findings in pediatric and adolescent patients presenting with non-traumatic visual disturbances who were subsequently found to have significant intracranial lesions on brain magnetic resonance imaging (MRI). In addition, we identified associated clinical factors that may guide the decision to perform brain MRI in such cases.Methods: We retrospectively reviewed the medical records of 63 patients aged ≤ 18 years who underwent brain MRI to evaluate the etiology of non-traumatic visual disturbances. Data collected included visual disturbance type, best-corrected visual acuity, pupillary light reflex, ocular movement, fundus photo, optical coherence tomography, visual field and brain MRI findings. MRI findings were classified as positive if the detected intracranial lesions could account for the patient’s visual symptoms. Ophthalmologic features were compared between patients with MRI-positive and MRI-negative findings to identify predictive clinical indicators.Results: The mean age of the patients was 8.6 years. The most common presenting symptom was decreased vision, reported in 35 patients. Brain MRI revealed positive findings in eight patients (12.7%), including four cases of brain tumors. Of the three patients with brain tumors who presented with decreased vision, one had a relative afferent pupillary defect (APD), whereas all patients exhibited pale disc and reduced retinal nerve fiber layer (RNFL) thickness. One patient with a brain tumor presented with exotropia, bilateral limitation of elevation, and disc edema. The presence of APD, pale disc, and decreased RNFL thickness exhibited a statistically significant association with positive brain MRI findings.Conclusions: Positive brain MRI findings were identified in 12.7% of pediatric and adolescent patients who presented with non-traumatic visual disturbances, with half of these cases attributed to brain tumors. Brain MRI should be significantly considered in patients with APD, pale disc, or reduced RNFL thickness.

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