Purpose or Case Report: Sudden visual impairment in children occurs sporadically, but when present needs urgent attention. Optimal management strategies and timely recognition are required. Often psychogenic disorders are the cause in school-age children; but this is a diagnosis of exclusion. Therefore, MRI plays an important role in ruling out pathology along the optic pathways or helping with the diagnosis of underlying life threatening diseases, such as hydrocephalus or intracranial mass. The purpose of this study was first to evaluate non-traumatic (tumoural and non-tumoural) causes of acute vision impairment; and second, to assess if conventional neuroimaging is helpful children with sudden visual impairment.
Methods & Materials: We retrospectively analysed the MRI scans and clinical findings of 95 children (47 male, 48 female; mean age: 12.5 years, range: from 2 to 17 years) who presented symptoms of monocular or bilateral acute vision impairment.

Results: Patients with acute visual impairment were usually older than 7 years. In 40% of the patients a correlation between the MRI findings and the clinical symptoms was found. The most common causes of visual impairment were: infectious diseases (16%), migraine (12%), autoimmune diseases (11%), optic nerve neuritis with unknown aetiology (8%), neoplasms (8%), idiopathic intracranial hypertension (5%) and orthostatic hypotension (4%). Still, in 23% of the patients the cause remained unclear.
Conclusions: Acute vision impairment is frequently caused by infectious diseases, migraine, autoimmune diseases or tumours in children. Despite the increased recognition of the different causes of the visual impairment with MRI; our analyses suggest that in most part of the paediatric patients the cause for acute visual impairment remains unclear.