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PubMed2004

Group B streptococcus endogenous endophthalmitis presenting as septic arthritis and a homonymous hemianopsia due to embolic stroke.

PURPOSE: To report a case of group B streptococcus (GBS) endogenous endophthalmitis in a patient presenting with septic arthritis and a homonymous hemianopsia due to embolic stroke. DESIGN: Observational case report. METHODS: A 75-year-old woman with septic arthritis and a homonymous hemianopsia due to embolic stroke was examined and found to have endogenous GBS endophthalmitis due to bacterial endocarditis. RESULTS: Magnetic resonance imaging showed many septic emboli to the brain, including the left occipital lobe. Fundus examination showed evidence for endogenous endophthalmitis. Blood and urine cultures were positive for GBS. A mitral valve vegetation was presumed to be the cause of the intracranial septic emboli and was demonstrated on transesophageal echocardiography. CONCLUSIONS: Septic arthritis and embolic stroke are suggestive of endocarditis and sepsis. Endogenous endophthalmitis in this case led to transesophageal echocardiography, which was diagnostic for endocarditis.

Aged↗
PubMed1991

[Homonymous hemianopsia].

Anatomical principles of the suprachiasmatic pathway. The neuro-ophthalmological examination of homonymous hemianopia: qualitative perimetry (confrontation tests), quantitative perimetry (campimetry on the Bjerrum screen, kinetic perimetry, static perimetry, automatic computer controlled perimetry, perimetry with colours, flickerfusion frequency-perimetry), oculomotor disturbances (gaze strategies, opto-kinetic nystagmus), pupillary disturbances, visual evoked potentials, anosognosia, Riddoch-phenomenom, hemiachromatopsia. Synopsis of different forms of homonymous hemianopsia: Unilateral, total or quadrant, bilateral, temporal half moon preserved or not, homonymous scotomas, horizontal hemianopsia. Pathogenetic analysis: tumors, infarcts, cerebral injuries, neuro-surgical operations, inflammatory conditions, congenital or perinatal brain damages, migraine. Additional disturbances of visual space recognition (hemineglect), of colour vision and of reading ability (alexia). In connection with the above mentioned theme appreciation of the scientific work of Prof. E. Aulhorn (Tübingen) regarding the perimeter apparatus, the perimetric examination technique and the interpretation of the perimetric results.

Brain Mapping↗
PubMed1988

[Hemianopsia and agnosia].

Hemianopsia and agnosia, the coexistence of a disorder of perception and a disorder of recognition, is exemplified by two patients chosen for their clinical similarity. These two patients each had a stroke, one of the left and the other of the right posterior cerebral artery, resulting right and left hemianopsia respectively. Primary visual functions such as visual acuity and contrast sensitivity were intact. The differences were only apparent as regards the severity of the agnostic disorders. The patient with the lesion on the left failed to recognize stylized drawings, was alexic, could not lipread and was color anomic, but could easily identify handwriting, faces, and voices. The patient with the right posterior lesion could not recognize handwriting, was prosopagnosic and topographagnosic, but had no difficulty in reading, lipreading, or in recognizing stylized drawings. The apparent double dissociation of function demonstrates the presence of two different visual processing mechanisms which are very probably peculiar to the visual system of the left hemisphere in the one case and to that of the right hemisphere in the other. The authors' findings suggest that the two cerebral hemispheres differ fundamentally in the way they process visual information.

Agnosia↗
PubMed1988

[Vascular cause of hemianopsia].

Hemianopsia of vascular origin can be caused by diseases in the carotid circulation (optic tract, proximal third of the optic radiation), as well as in the vertebrobasilar arterial system (middle and distal thirds of the optic tract, striate area/calcarina). Hemianopsia of ischemic origin must be differentiated from hemianopia in the presence of an enlarging aneurysm, a space-occupying intracranial lesion (hemorrhage, neoplasia), and inflammatory disease, occasionally in metabolic disorders. To detect the exact cause of a hemianopia in a given patient, recording of the patient's precise history and clinical-neurological, clinical-ophthalmological, and clinical-internal examinations are mandatory, as well as additional diagnostic procedures. Of these, the most important are neurovascular ultrasound examinations (extracranial, transcranial and B-mode/duplex Doppler examination), CT and MRI scans, and cardiological examination with echocardiography. The choice of these additional and costly examinations and their sequence in the diagnostic work-up in a given patient has to be adapted to the patient.

Aged↗
PubMed1988

[Functional monocular hemianopsia].

Certain patients with reduction or loss of central visual function and/or hemianopic changes of the visual field can be classified as well-informed malingerers, individuals who are easily influenced by suggestion, or neurotics suffering from "conversion hysteria." The main symptom is one of a functional sensory change (loss or reduction of visual field). The task falling to the ophthalmologist is to prove the contrary, using certain subjective and objective tests to prove the incompatibility of the results with the physiological facts. The authors discuss the specificity of these tests in this context and present a number of cases with the characteristic temporal or nasal functional hemianopsia comparing them with patients who have hemianopsias due to real anatomic lesions.

Adolescent↗
PubMed1994

The triad of left hemiplegia, hemihypesthesia, and homonymous hemianopsia: implications for rehabilitation.

Patients with carotid cerebrovascular disorder can be categorized as having either right hemiplegia with various degrees of aphasia, left hemiplegia with hemihypesthesia, or homonymous hemianopsia, or the triad of left hemiplegia, hemihypesthesia and homonymous hemianopsia. The purpose of this study was to compare the functional performance of patients with each type of carotid cerebrovascular disorder before and 1 year after comprehensive rehabilitation aimed at improving communication and/or functional skills. Performance was measured using both the Barthel Index and Williams Drawing Test. On average, patients with the triad of neurologic deficits started and finished with poorer functional performance than the other patients. However, the average gain in functional scores over time was similar for all groups.

Activities of Daily Living↗
PubMed2003

Dermatochalasis causing apparent bitemporal hemianopsia.

We describe a previously unreported cause of apparent bitemporal hemianopsia. Three patients with bilateral dermatochalasis underwent Humphrey visual field (HVF) testing in anticipation of corrective blepharoplasty. Unexpectedly, the HVF showed bitemporal hemianopsia in each case, prompting magnetic resonance imaging of the brain in one case. The scan was negative. The HVF tests were repeated with the upper eyelids taped in elevation, and were normal. We conclude that the bitemporal hemianopic defects in our patients resulted from the testing strategy employed by the HVF analyzer software to measure the visual field. Reasons for these artifactual results are discussed. Clinicians should be aware of this uncommon cause of bitemporal hemianopic visual field defects.

Aged↗
PubMed1977

Does alexia without agraphia always include hemianopsia?

A patient with alexia without agraphia (pure alexia) is reported. Bedside examination of the visual fields disclosed no abnormalities; but perimetric examination demonstrated an incomplete right homonymous hemianopsia with some sparing of the peripheral part of the visual field. The literature on pure alexia without hemianopsia is reviewed and it is concluded that this syndrome has hardly been described with certainity.

Dyslexia, Acquired↗
PubMed1998

Homonymous hemianopsia as the initial manifestation of multiple sclerosis.

A 28-year-old male patient in good health with no previous neurologic or ophthalmoscopic abnormalities developed right homonymous hemianopsia. Magnetic resonance (MR) imaging demonstrated bilateral high-signal suprageniculate lesions. The lesion located in the left parieto-occipital area was compatible with the field defect observed. Oligoclonal bands were present in the cerebrospinal fluid. Testing of visual-evoked potentials revealed increased latencies in both eyes. The patient was given 1 g/day intravenous methylprednisolone for 3 days. The visual fields, as determined by automated static perimetry, recovered completely in 2 weeks. Follow-up MR imaging at 1 month showed no change compared to baseline. Seven months after the initial attack he suffered right internuclear ophthalmoplegia, which resolved spontaneously within 1 week. Based on the clinical and radiologic findings, the final diagnosis was made as clinically definite multiple sclerosis (MS). This patient represents a rare case of MS presenting first with homonymous hemianopsia.

Adult↗
PubMed1988

Giant aneurysm arising from the anterior cerebral artery and causing an isolated homonymous hemianopsia.

A case of a giant aneurysm arising from the anterior cerebral artery and producing a left homonymous hemianopsia is presented. The aneurysm caused lateral compression of the posterior part of the optic chiasm. After preoperative dynamic assessment of the circle of Willis by angiography and by electroencephalographic recording during carotid artery compression, the aneurysm was trapped with microclips on the anterior cerebral artery proximal and distal to it. Visual field examination 6 months postoperatively showed complete visual field recovery. This is the first case of homonymous hemianopsia caused by an angiographically proven giant aneurysm of the ACA.

Cerebral Angiography↗
PubMed1992

Bilateral homonymous hemianopsia due to tentorial herniation, with sparing of central vision: case report.

Cases of complete bilateral homonymous hemianopsia with sparing of central vision that are caused by bilateral tentorial herniation are extremely rare. We describe one such case resulting from severe head trauma, the first to be reported in which magnetic resonance images showed clear evidence of the responsible lesion. The causes of bilateral homonymous hemianopsia with sparing of central vision and the possible mechanisms whereby macular sparing may arise are discussed.

Adolescent↗
PubMed1999

[A case of systemic lupus erythematosus associated with thrombotic thrombocytopenic purpura manifestating homonymous hemianopsia].

We report on a 35-year-old Japanese woman with systemic lupus erythematosus (SLE) in whom homonymous hemianopsia developed. In August 1987, SLE was diagnosed. In November 1987, the patient was admitted to our hospital because of severe thrombotic thrombocytopenic purpura; however, clinical symptoms improved after treatment with vincristine. In 1992, severe lupus nephritis developed but improved after steroid therapy. In February 1994, diplopia developed owing to inflammatory invasion of the orbit by acute maxillary sinusitis. Humphrey Field Analyzer perimetry revealed a homonymous quadrantic hemianopic scotoma in the lower left side. Magnetic resonance imaging of the brain revealed a small infarct lesion in the posterior pole of the upper calcarine cortex. This lesion was thought to be responsible for homonymous hemianopsia. However, the lesion was not visualized with computed tomography. Our experience in the present case suggests that magnetic resonance imaging is more useful than computed tomography for identifying lesion causing visual field disorders in SLE.

Adult↗
PubMed1999

Hemianopsia related to dissection of the internal carotid artery.

Spontaneous dissection of the internal carotid artery is typically associated with cerebral vascular infarction along the anterior and middle cerebral distribution, whereas occipital infarction is usually related to posterior circulation abnormalities. Hemianopsia with occipital infarction related to carotid artery dissection has therefore rarely been reported. A 40-year-old woman in whom acute-onset hemianopsia developed, related to occipital infarction secondary to internal artery dissection, is described. This atypical association is explained by anatomic variations of the posterior part of the circle of Willis. Neuroimages showed occipital infarction related to internal carotid artery dissection associated with hypoplasia of the proximal portion of the cerebral posterior artery (P1). The anatomic correlation of this atypical association and a review of the literature are presented.

Adult↗
PubMed1979

[A case of multiple fusiform aneurysms presenting homonymous hemianopsia (author's transl)].

Fusiform Aneurysms are encountered in elderly persons with advanced arteriosclerosis. When they are enlarged to compress the neighboring structures, they may resemble tumors symptomatically. Especially when situated in close relation to the optic nerve or chiasmatic region, pituitary tumor is likely to be suspected. This is a case of 62 year old female with a giant fusiform aneurysm of the right internal carotid artery extending to the middle cerebral artery which caused left homonymous hemianopsia and a large aneurysm in the cavernous portion of the left internal carotid artery with fusiform extension of the distal portion of the carotid artery which presented left blepharoptosis, dilated pupil and total ophthalmoplegia. The basilar artery and the right meningohypophyseal artery showed fusiform dilatation as well. Systemic atherosclerotic change, abdominal aortic aneurysm, nephrosclerosis were also accompanied. The computed tomography demonstrated the aneurysms distinctly. Left oculomotor palsy disappeared after six months with residue of left homonymous hemianopsia. Surgical intervention was not attempted, because of the widely distributed constitutional aneurysms in the whole body.

Carotid Artery, Internal↗
PubMed1977

Homonymous hemianopsia and rehabilitation in fifteen cases of C.C.I.

Fifteen cases of severe cranio-cerebral injuries (C.C.I.) with hemianopsia and rehabilitation problems are presented. The correlation between the side of the hemianopsia, dexterity, visual motor organization, intellectual functions and rehabilitation outcome are discussed.

Brain Injuries↗
PubMed1978

Traumatic bitemporal hemianopsia and diabetes insipidus.

Bitemporal hemianopsia and diabetes insipidus are infrequently occurring complications of closed head injuries. Porter and Miller found 18 cases of posttraumatic diabetes insipidus among more than 5000 patients with nonfatal closed head injuries. Of these, five also manifested damage to the optic chiasm. In 1971 Laursen surveyed the literature regarding traumatic bitemporal hemianopsia and found associated diabetes insipidus in 26 of 50 patients for whom information on this was given. Both conditions were present in a patient seen at Walter Reed Army Medical Center.

Adult↗
PubMed1994

[A 37-year-old man with memory loss, homonymous hemianopsia, and elevation of anti-herpes simplex virus antibody titer].

We report a 37-year-old man who presented memory loss, homonymous right hemianopsia, and elevation of anti-herpes simplex antibody titer. He had an auto accident in January 1992 in that the car he was driving slipped down a 3 m slope; his car was severely damaged, however, he himself was not injured. Shortly after this accident, he went out of his house less often than before, and he noted some difficulty in his vision. He changed his glasses twice, but his vision was unchanged. In July of 1992, he had an onset of difficulty in recent memory and disorientation to time. He also noted diplopia, and difficulty in seeing objects in his right visual field. He was admitted to our hospital on August 26 of the same year. General physical examination was unremarkable. On neurologic examination, he was alert but disoriented to time and place; calculation was also impaired. Mini-mental state examination was 18/30. He had no aphasia, apraxia, or agnosia. He showed a tendency to neglect his left side. Optic fundi and visual acuity were normal; right homonymous hemianopsia was present. Ocular movement was moderately restricted to most of the directions; pupils were isocoric and reacted to light promptly. He complained of diplopia in right gaze, and monocular nystagmus was induced in his right eye upon right lateral gaze. Trigeminal nerves appeared intact. Minimum left facial weakness was present. The remaining of the cranial nerves appeared intact. His gait was wide-based and tandem gait was impossible. Muscle strength was normal as was the muscle tone. Finger to nose and heel to knee tests were done normally.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Large anterior communicating artery aneurysm with temporal hemianopsia. Case report.

Giant or large anterior communicating artery (ACOA) aneurysms producing bitemporal hemianopsia are extremely rare. A case is presented of an ACOA aneurysm measuring 2 X 1.4 cm with the patient having had a post-traumatic amaurosis of the left eye for many years. Then he had a subarachnoid hemorrhage and subsequently developed impaired vision in the right eye and temporal hemianopsia. The aneurysm was visible on C.T. but disappeared on post-operative scans. Visual acuity improved radically after treatment with neck ligation and opening of the sac.

Angiography↗