homonymous hemianopia in occipital infarct

We present a case of an older patient with toxic chiasmatic optic neuropathy accompanied by bitemporal hemianopia associated with ethambutol use. The patient experienced gradual visual defect recovery that was concurrent with an improvement of chiasmal enhancement in the repeat magnetic resonance imaging performed at his 6-month follow-up. However, his visual field pattern sharply changed to left inferior homonymous quadrantanopia because of a new episode of occipital lobe infarction. After 2 years, the patient's visual function reached the best-corrected visual acuity of 20/20 in both eyes, although he had the sequela of homonymous quadrantanopia related to the infarction...

Posterior cerebral artery (PCA) territory infarction involving occipital cortical damage can give rise to contralateral homonymous hemianopia. Here, we report two rare cases of patients with lesions in the left hemisphere PCA territory who developed right visuo-spatial neglect. One patient suffered right hemianopia and right visuo-spatial neglect after a stroke that damaged the left primary visual cortex and the callosal splenial fibers. The other unique case is of a patient who had a brain tumor in the posterior cerebral region in the left hemisphere and initially exhibited only right hemianopia that developed into right visuo-spatial neglect after tumor resection that included the splenial fibers...

Carotid artery dissection is a significant cause of stroke in young patients. Here, we report a 33-year-old male who presented with right homonymous hemianopia and paresthesia of the right side of the body. Magnetic resonance imaging (MRI) of the brain revealed an acute infarct in the left parieto-occipital region. Magnetic resonance angiography (MRA) and duplex ultrasonography (USG) of the neck vessels suggested the left internal carotid artery dissection as the underlying cause. The patient was a known human leukocyte antigen (HLA) B27 and had a history of a previous attack of uveitis...

Since the emergence of the coronavirus disease 2019 (COVID-19) pandemic, multiple but rare complications of this infection have been described, comprising cerebral venous sinus thrombosis (CVST) and immune thrombocytopenic purpura (ITP). Although these two complications have been reported as separate entities, to the best of our knowledge, their concurrent presentation has not been reported. In this case report, we present a middle-aged man with a history of COVID-19 infection who developed a sudden-onset severe occipital headache followed by right-sided blindness (right homonymous hemianopia)...

Patients with homonymous hemianopia sometimes show preservation of the central visual fields, ranging up to 10°. This phenomenon, known as macular sparing, has sparked perpetual controversy. Two main theories have been offered to explain it. The first theory proposes a dual representation of the macula in each hemisphere. After loss of one occipital lobe, the back-up representation in the remaining occipital lobe is postulated to sustain ipsilateral central vision in the blind hemifield. This theory is supported by studies showing that some midline retinal ganglion cells project to the wrong hemisphere, presumably driving neurons in striate cortex that have ipsilateral receptive fields...

OBJECTIVES: Homonymous hemianopia (HH) is the most frequent visual-field defect after a stroke. Some of these patients also have visual hallucinations, the origin and frequency of which remain largely unknown. The aims of this work were to determine the occurrence of visual hallucinations among poststroke hemianopic patients in function of the location (Brodmann areas) of the brain lesion, as determined by MRI, and to study the neuroanatomic correlates of these hallucinations by nature, frequency, and type...

A 70-year-old right-handed man noticed that the right side of the screen on his television displayed a time lag compared to the other side. For five days before admission, he had characteristic polyopia, visual photopia, and complex hallucination. Upon neurological examination, he showed no abnormal findings except for right homonymous hemianopia. MRI showed acute infarction of the occipital gyri and part of the lingual gyrus in the left occipital lobe. After admission, he experienced various visual hallucinations and visual illusions, including metamorphopsia and micropia, many times...

GCA, the most common systemic arteritis, affects medium-sized and larger extradural arteries that have the internal elastic lamina. Involvement of the ophthalmic artery and its branches results in visual loss, which is often complete but is usually painless. Visual loss may be monocular or binocular developing simultaneously or sequentially. Rarely, it stems from occipital lobe infarct that result in homonymous hemianopia, a visual field defect involving the two identical halves (right or left) of the visual fields of both eyes...

An 82-year-old woman with polymyalgia rheumatica (PMR) on prednisone 7 mg daily was admitted to an acute stroke unit with a right homonymous hemianopia, a left posterior cerebral artery occlusion and occipital lobe infarct. She had raised inflammatory markers, did not have a temporal artery biopsy, and was discharged on the same dose of prednisone. After 21 months, off prednisone, her ophthalmologist, concerned about giant cell arteritis (GCA), restarted prednisone 40 mg daily, with rapid, profound visual improvement...

RATIONALE: Occlusive cerebrovascular disease is the most common cause of homonymous hemianopia (HH) with macular sparing. PATIENT CONCERNS: A 61-year-old man came to our ophthalmology clinic complaining of right-side hemianopia. Ophthalmic examination, visual field (VF) examination, and brain magnetic resonance imaging (MRI) were performed. DIAGNOSES: He had right HH without macular sparing on the initial VF test. And brain MRI 6 days after the visual symptoms began revealed a left occipital infarction...

Pure alexia refers to an acquired disorder associated with the damage to medial occipitotemporal gyrus in the dominant hemisphere, which is also known as visual word form area (VWFA). VWFA is involved in rapid word recognition and fluent reading. Alexia without agraphia is a disconnection syndrome that occurs when the splenium is also damaged with the occipital lobe on a dominant side. We report a case of a 72-year-old right-handed male who presented with alexia without agraphia accompanied by right homonymous hemianopia resulting from acute infarct of the left occipital lobe, the splenium of the corpus callosum and posterior thalamus that probably occurred on the previous day...

A woman aged 26 years was referred by her GP to the eye casualty department with sudden-onset left homonymous hemianopia and right-sided headache. Full ophthalmic examination was normal with the exception of a left homonymous hemianopia confirmed with automated perimetry. Urgent CT imaging revealed a non-haemorrhagic cerebral infarct in the right parieto-occipital region. Subsequent blood tests confirmed a diagnosis of antiphospholipid syndrome with positivity in IgG anticardiolipin antibody, IgG anti-β2-GP1 antibody and the Lupus anticoagulant screen...

Damage to the visual cortex or the geniculostriatal pathways could cause homonymous visual field (VF) defects at the contralateral side of the lesion. In clinical practice, it is known that the VF defects are gradually recovered over months on the cases. We report a case with recovered homonymous hemianopia following an infarction in the visual cortex by positron emission tomography (PET) with (18)F-fluorodeoxyglucose (FDG) and (11)C-flumazenil (FMZ). A 58-year-old man experienced defect of left VF, and magnetic resonance imaging (MRI) revealed a localized infarction in the right occipital lobe...

Visual hallucinations represent the dissociation between visual perception and sensory input. We present the case of a 31-year old patient who perceived continuous unformed hallucinations in the hemianopic field immediately following right occipital cortex stroke, which have remained unchanged over 2 years. We performed 1 Hz repetitive transcranial magnetic stimulation (TMS) to the lesioned area for 30 minutes per day over 5 days in an attempt to suppress the perpetual hallucinations. fMRI was performed prior to and after TMS treatment to assess plasticity changes...

BACKGROUND: Peripheral homonymous scotomas beyond 30° from fixation are rare. The paucity of publications describing such visual field defects might be attributed to various factors, including the absence of severe symptoms, routine visual field assessment restricted to the central 30° with automated perimetry, and the collateral circulation to the occipital cortex. The aim of this study was to correlate the brain lesions and perimetric findings in 2 unusual cases of peripheral homonymous scotomas, with the anatomic location of the optic radiation and primary visual cortex...

Disorders of the optic tract, lateral geniculate nucleus, optic radiation, and occipital lobe - collectively called the retrochiasmal visual pathways - are commonly encountered in neurological practice, and may result from a number of causes. The major visual morbidity of retrochiasmal disease is the homonymous visual field defect, which is found in approximately 8% of stroke patients. A homonymous visual field defect may have profound legal, occupational, and financial consequences for patients, with many patients unable to read, drive, or return to work after sustaining retrochiasmal damage...

BACKGROUND: To describe a rare presentation of vertebral artery dissection (VAD) as a small but congruous incomplete homonymous hemianopia demonstrating use of visual field testing in the diagnosis. CASE PRESENTATION: A 30 year old woman had been unwell for 4 months with difficulty focusing, vertigo, dizziness and a feeling of falling to the right. A small but congruous right inferior homonymous quadrantanopia was found on examination leading to further investigation that uncovered a vertebral artery dissection and multiple posterior circulation infarctions including a left occipital stroke matching the field defect...

INTRODUCTION: For occipital cortex strokes resulting in vision disorders, questions about the viability of residual visual cortex remain. CLINICAL PICTURE: In a patient with a one-year-old, left, complete, homonymous hemianopia due to a right, posterior cerebral artery, ischaemic infarct, we assessed the visual cortex with fMRI retinotopic mapping prior to starting vision restoration therapy. OUTCOME: The patient was found to have residual neurovascular function and retinotopic representation in the surviving visual cortex around the infarcted area...

Occipital stroke and occipital epilepsy are possible manifestations of mitochondrial diseases. A previous study in northern Finland suggested a frequency of 10% for mitochondrial disorder in young patients with stroke. Here we studied the epidemiology of occipital brain infarcts in a defined population in southwestern Finland. Patients diagnosed with brain infarct or visual field defect with onset at the ages of 18-45 years were identified from the discharge files at the Turku University Hospital. We further ascertained those patients with an occipital brain infarct in brain imaging or homonymous hemianopia with no signs of other etiology in brain imaging...

A 28-year-old man developed cerebral blindness from infarction of both mesial occipital lobes after cardiogenic hypotension induced by electrical shock. He remained globally encephalopathic for several weeks, but his most enduring deficit was bilateral homonymous hemianopias with macular sparing. Cerebral visual loss after electrical injury has been sparsely reported. It has been attributed to direct thermal injury of the skull or posterior dural venous sinuses. We suggest that cerebral blindness after cardiogenic hypotension in which there is no thermal injury to the scalp be attributed to hypotensive infarction of the mesial occipital lobes, which lie in the terminal domain of the posterior cerebral arteries...