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homonymous hemianopia in occipital infarct

Donald H Gutteridge, Frank L Mastaglia
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...
October 2017: Internal Medicine Journal
Hye-Young Shin, So Hee Kim, Mee Yon Lee, Su Young Kim, Young Chun Lee
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...
July 2017: Medicine (Baltimore)
Chintan Rupareliya, Syeda Naqvi, Seyedali Hejazi
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...
June 2, 2017: Curēus
Derek Kwun-Hong Ho, Rishi Ramessur, Mradul Gupta, John P Mathews
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...
February 8, 2017: BMJ Case Reports
Yukihisa Suzuki, Motohiro Kiyosawa, Keiichi Oda, Kiich Ishiwata, Kenji Ishii
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...
April 2016: Tohoku Journal of Experimental Medicine
Sara Rafique, John Richards, Jennifer Steeves
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...
2015: Journal of Vision
Eleni Papageorgiou, Luca F Ticini, Ulrich Schiefer
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...
March 2012: Journal of Neuro-ophthalmology: the Official Journal of the North American Neuro-Ophthalmology Society
J Alexander Fraser, Nancy J Newman, Valérie Biousse
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...
2011: Handbook of Clinical Neurology
Albert I Matti, Andrew W Lee, Celia S Chen
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...
May 19, 2010: BMC Ophthalmology
Yi-Ching Ho, Amandine Cheze, Yih-Yian Sitoh, Esben Thade Petersen, Kong-Yong Goh, Albert Gjedde, Xavier Golay
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...
September 2009: Annals of the Academy of Medicine, Singapore
Mika H Martikainen, Kari Majamaa
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...
February 2010: Journal of Neurology
Roheena Kamyar, Jonathan D Trobe
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...
June 2009: Journal of Neuro-ophthalmology: the Official Journal of the North American Neuro-Ophthalmology Society
Gereon Nelles, Anja Pscherer, Armin de Greiff, Michael Forsting, Horst Gerhard, Joachim Esser, H Christoph Diener
Substantial disability in patients with hemianopia results from reduced visual perception. Previous studies have shown that these patients have impaired saccades. Improving exploratory eye movements with appropriate training of saccades may help to partially compensate for the visuoperceptive impairment during daily life activities. The changes in cortical control of eye movements that may be induced by these training strategies, however, are not known. We used functional magnetic resonance imaging (fMRI) to study the training effects of eye-movement training on cortical control of saccades...
May 2009: Journal of Neurology
Sansal Gedik, Ahmet Akman, Yonca A Akova
AIMS: To compare the efficiency of Rarebit perimetry and the Humphrey field analyser (HFA) in detecting the homonymous hemianopia in stroke patients with occipital lobe infarcts. METHODS: 40 patients who suffered from visual complaints caused by acute occipital lobe infarcts underwent visual field analysis on the same day, in random order-first with either Humphrey perimetry 30-2, SITA standard program (Zeiss Humphrey Systems) or Rarebit perimetry. A visual field was classified into four quadrants for right and left eyes: superior temporal, superior nasal, inferior temporal, and inferior nasal...
August 2007: British Journal of Ophthalmology
Xiaojun Zhang, Sachin Kedar, Michael J Lynn, Nancy J Newman, Valérie Biousse
BACKGROUND: Previous reports have suggested that most cases of homonymous hemianopia (HH) are caused by occipital stroke. However, these reports have not always been supported by brain imaging. METHODS: We reviewed the medical records of all patients seen in our unit between 1989 and 2004 who had HH documented by formal perimetry or confrontation visual fields and had undergone brain imaging. HHs were divided into those caused by stroke and by non-stroke conditions...
September 2006: Journal of Neuro-ophthalmology: the Official Journal of the North American Neuro-Ophthalmology Society
Sachin Kedar, Xiaojun Zhang, Michael J Lynn, Nancy J Newman, Valérie Biousse
INTRODUCTION: Homonymous hemianopia is a disabling condition caused by numerous lesions affecting the retrochiasmal visual pathways. Little is known about homonymous hemianopia in childhood. METHODS: All patients seen in the Neuro-Ophthalmology Unit at Emory University with homonymous hemianopia (confirmed by Goldmann, Humphrey, or confrontation visual fields) between 1989 and 2004 were included. Demographic characteristics, clinical features, and evolution of the visual field defects were compared between the pediatric group (18 years of age or younger) and the adult group (older than 18 years)...
June 2006: Journal of AAPOS: the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus
Nese Celebisoy, Ayse Sagduyu, Ceyla Atac
A 26-year-old right handed female was admitted to hospital with right homonymous hemianopia associated with alexia without agraphia. Her cranial magnetic resonance imaging and magnetic resonance angiography revealed a left occipital venous infarction due to thrombosis of the left transverse, sigmoid sinuses and the left internal jugulary vein. The underlying conditions were protein C and protein S deficiency associated with the use of oral contraceptives. To our knowledge, alexia without agraphia has never been described due to a venous infarction associated with hereditary thrombophilia in the literature...
December 2005: Clinical Neurology and Neurosurgery
Iris Ben-Bassat Mizrachi, Alvin H Schmaier, Jonathan D Trobe
A 73-year-old woman developed mental confusion and finger pain after treatment with enoxaparin following arthroplasty. A platelet count was 163,000/microL. Because digital embolism was suspected, she was emergently treated with heparin and recombinant tissue plasminogen activator (rTPA). During rTPA infusion, she reported sudden hemifield loss, so the infusion was aborted. Brain CT disclosed a non-hemorrhagic occipital infarct. Platelets had fallen to 63,000 over eight days, and antibodies against a complex of heparin and platelet factor 4 were detected...
September 2005: Journal of Neuro-ophthalmology: the Official Journal of the North American Neuro-Ophthalmology Society
Marjorie A Murphy, Mitra Ayazifar
A 34-year-old woman with eclampsia and the hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome developed encephalopathy, cardiomyopathy, pulmonary edema, liver failure, and disseminated intravascular coagulation (DIC), all of which resolved. She also had retinal hemorrhages in both eyes and a hemorrhagic infarct in the left occipital lobe that resulted in a permanent right homonymous hemianopia and a persistently depressed acuity of 20/100 OS. This case is unusual in demonstrating permanent visual deficits...
June 2005: Journal of Neuro-ophthalmology: the Official Journal of the North American Neuro-Ophthalmology Society
A I Klistorner, S L Graham, J Grigg, C Balachandran
AIMS: To examine the ability of the multifocal pattern visual evoked potential (mVEP) to detect field loss in neurological lesions affecting the visual pathway from the chiasm to the cortex. METHOD: The mVEPs recorded in the clinic were retrospectively reviewed for any cases involving central neurological lesions. Recordings had been performed with the AccuMap V1.3 objective perimeter, which used an array of four bipolar occipital electrodes to provide four differently oriented channels for simultaneous recording...
June 2005: British Journal of Ophthalmology
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