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PubMed1997

Visual field enlargement by neuropsychological training of a hemianopsia patient.

A 58-year old hemianopsia patient was submitted to a two-fold neuropsychological training in order to enhance visual functions in the affected part of his visual field. At first, the visual field was measured perimetrically, to serve as a starting measurement with which after-measurements could be compared. Then, the first training was started: the border area between the intact and the defect visual field was being stimulated by small light spots. The training consisted of repetitive detection threshold measurements. After 27 one-hour sessions, the visual field was being measured again. The visual field appeared to have been enlarged 5 to 12 degrees in the direction of the affected hemifield and contrast-sensitivity thresholds to have been decreased almost at every point in the stimulus-array. Then, a second training started; an eye-movement training. Again, the border area, now shifted outwards, was stimulated. This time, the stimulus concerned a short presentation of light (< 200 msec.) after which the subject, to the best of his abilities had to make an eye-movement to the perceived stimulus-site. Also, he had to categorize the quality of his perception as well as the direction in which the stimulus was thought to be perceived. After 30 sessions, the visual field appeared to have 'grown' just a little bit more, but this seems not to be a significant enlargement. More important, the number of detected stimuli in the supposed 'blind' area had increased, as had the accuracy of the localization of the stimuli. Preliminary results of the detection training of a second subject, also 58 years of age, are presented. Finally, planned actions are discussed.

Eye Movements↗
PubMed1983

Perimetry, visual evoked potentials and visual evoked spectrum array in homonymous hemianopsia.

Confrontation field examination, perimetry, visual evoked potentials (VEPs) to pattern hemi-field stimulation and visual evoked spectrum array to flash stimulation were compared in 50 patients with homonymous hemianopsia. Visual field could be examined by confrontation in all patients and demonstrated the field defect in 96% of cases. Goldmann perimetry could only be performed in 60% of patients, but always quantitatively defined the margins of the defect. VEPs could only be tested in 77% of patients and demonstrated an abnormality in 79% of cases. VEPs were absent to stimulation of the affected hemifield in every case of homonymous field defects with macular splitting. Visual evoked spectrum array could be tested in 95% of patients and revealed abnormalities in 67% of cases. The relative value of each test is discussed.

Adult↗
PubMedDate not supplied

Functional hemianopsia: a historical perspective.

The controversial history of functional hemianopsia is reviewed from Briquet's 1859 monograph on 430 cases of hysteria, through the 19th century works of Charcot, Freud, and Janet, and the observations of Fox and Wilbrand and Saenger in the early 20th century. More recently, concepts of this entity have been clarified by modern binocular testing of visual fields.

France↗
PubMed1995

Crossed quadrant homonymous hemianopsia in a case of multiple sclerosis.

We describe the first report of crossed quadrant hemianopsia (CQHH) occurring in a patient with a well documented clinical history of Multiple Sclerosis (MS). The visual field studied by a Humphrey Field Analyzer (Mod.630, 30-2 program) showed a CQHH, involving right superior quadrants and left inferior ones. Magnetic resonance imaging (MRI) showed two lesions located in both left and right trigone area, corresponding to the geniculocalcarine pathways. CQHH is a very rare visual field defect commonly caused by vertebro-basilar ischemia and attributed to bilateral injury of the calcarine fissure. In the absence of lesions in the primary visual cortex, a direct relationship between the quadrantonopic defect and two small demyelinating lesions in posterior periventricular white matter, corresponding to the geniculocalcarine pathways, is implied.

Adult↗
PubMed2006

Discordance between subjective perimetric visual fields and objective multifocal visual evoked potential-determined visual fields in patients with hemianopsia.

PURPOSE: To investigate the concordance between subjectively and objectively acquired visual fields in patients with subjectively determined hemianopsia. DESIGN: Retrospective observational study. METHODS: Ten patients, six men and four women, ranging in age from 28 to 68 years, were studied. Goldmann or Humphrey perimeters were used to obtain the subjectively determined visual fields for up to 25 degrees of eccentricity, and the VERIS Scientific System (Electro-Diagnostic Imaging, San Francisco, California, USA) was used to record multifocal visual evoked potential [VEPs] (mfVEPs) to obtain the objective visual fields. Each of the 60 black-and-white segments of the checkerboard stimulus was alternated according to a binary m sequence. The first slices of the second-order kernels were extracted and analyzed. RESULTS: In five cases, the visual field loci where the mfVEPs were within normal limits corresponded to the scotomatous areas obtained by conventional perimetry. In these discordant cases, the lesions (e.g., arteriovenous malformation) were located in the occipital lobe. Two of these cases had a complete recovery of the subjective visual field. The lesions of the concordant cases were located outside the occipital lobe (e.g., pituitary adenoma). In these cases, no visual field improvement was seen. The temporal crescent syndrome was ruled out in patients with posterior lesions by computed tomography (CT) or magnetic resonance imaging (MRI) findings. CONCLUSIONS: In some patients with occipital lesions, the subjective and objective visual field results are discordant, and some of them will show a recovery of the visual field deficits.

Adult↗
PubMed2004

Development of tuberculoma during therapy presenting as hemianopsia.

A 6-year-old, previously healthy male presented with fever and lethargy. Tuberculous meningitis was suspected after cerebrospinal fluid examination. Antituberculous drugs were administered, and an initial computed tomographic scan of brain revealed mild ventriculomegaly only. Steroids were instituted on day 16 and gradually withdrawn 1 month later. Nine weeks after the initiation of antituberculous therapy, markedly impaired visual acuity and bitemporal hemianopsia were observed. Magnetic resonance imaging of brain revealed multiple tuberculomas, including involvement of the optic chiasm. Hydrocephalus was present. A ventriculoperitoneal shunt was inserted, and steroids were reinstituted. Visual acuity improved 9 weeks after the onset of visual acuity impairment and returned to normal 24 weeks later.Follow-up computed tomographic scan of brain 1 year later demonstrated complete resolution of tuberculomas. Development of intracranial tuberculoma during antituberculous therapy, although rare, dose not represent treatment failure, and continuation of antituberculous drugs, with or without the addition of steroids, will usually resolve the lesions.

Child↗
PubMed1996

Functional magnetic resonance imaging in homonymous hemianopsia.

PURPOSE: We performed functional magnetic resonance imaging associated with brain activity to evaluate the abnormality of the visual pathway in hemianoptic patients. METHODS: We studied five patients with homonymous hemianopsia caused by retrochiasmal lesions and five control subjects. On the basis of a blood oxygenation level-dependent contrast mechanism, magnetic resonance imaging was performed with a standard clinical 1.5-tesla system. We evaluated the asymmetrically increased signal intensities in the calcarine cortex during visual stimulation and compared them with the findings of Goldmann perimetry. RESULTS: Cortical activations with a marked interhemispheric contrast of the primary visual cortex consistent with the visual field defects were observed in three of the five patients. In two of the patients without macular field preservation in the defective hemifield, functional magnetic resonance imaging showed an absence of response in the primary visual cortex of the affected side. In the patient with superior quadrantanopsia, we could detect clear laterality by selecting the imaging plane inferior to the calcarine fissure. The other two hemianoptic patients with macular sparing showed symmetric responses. CONCLUSIONS: These findings suggest that functional magnetic resonance imaging is valuable in assessing local brain function in patients with visual deficits; therefore, it is a promising method for the objective detection of abnormalities in the afferent visual system.

Adolescent↗
PubMed1991

Hemianopsia from occipital lobe abscess after dental care.

We treated four patients who developed a homonymous hemianopsia from a bacterial abscess in the occipital lobe of the brain. All four patients were treated successfully by surgical drainage of the abscess and administration of parenteral antibiotics for at least six weeks. Despite cure of the brain abscess, each patient was left with a permanent residual homonymous visual field defect. Cultures from the abscess fluid in three of the four patients grew oral flora. Moreover, each patient had a history of dental care two to four weeks before the onset of visual symptoms. A history of recent dental treatment in a patient with a new hemianoptic field defect should alert the ophthalmologist to the possibility of a bacterial abscess in the occipital lobe.

Adolescent↗
PubMed1996

Sudden "stroke-like' onset of homonymous hemianopsia due to bacterial brain abscess.

A previously healthy 40-year-old man experienced the sudden 'stroke-like' onset of homonymous hemianopsia due to a bacterial brain abscess. Clinical features and initial computed tomography (CT) suggested a stroke. Subsequent CT and magnetic resonance (MR) demonstrated a cerebral abscess, proven at surgery. It is extremely rare that a healthy individual without various risk factors, such as congenital heart disease, immunologic deficiency, diabetes mellitus, or pregnancy, presents with the above symptoms. The exact mechanism of this sudden 'stroke-like' onset in a patient with a bacterial brain abscess is unknown. One possibility is that paroxysmal septic emboli led to abscess formation within or near areas of embolic infarction. Another possibility is that a primary cerebral infarction was associated with secondary bacteremia. Surgical drainage revealed a bacterial (Streptococcus) abscess, but no identifiable source of infection.

Adult↗
PubMed1998

Volitional control of homonymous hemianopsia: a single case study.

A 52-year-old woman suffered a posterior left hemisphere infarction involving the geniculo-striate system with right homonymous hemianopsia. Eighteen months after the stroke, we used perimetry and PET imaging of cerebral blood flow to demonstrate the patient's volitional control over the size of the scotoma. The volitional control could be eliminated with competing cognitive tasks. Significant increases in cerebral blood flow in contralateral medial prefrontal cortex, and in ipsilateral dorsolateral frontal convexity, temporoparietal and insular cortex were associated with volitional control of the visual field defect.

Brain↗
PubMed1999

Traumatic cataract presenting with unilateral nasal hemianopsia.

A 56-year-old man developed a nasal field defect in his left eye 3 months after a traumatic accident. An examination showed a posterior subcapsular cataract in the left eye with no neurologic deficits. Humphrey 24-2 visual field testing revealed a nasal hemianopsia in the left eye. After cataract extraction and intraocular lens implantation, the patient's visual field returned to normal. This case shows that a cataract can present with a localized visual field deficit, which may be corrected by cataract extraction.

Cataract↗
PubMed2000

[Bilateral inferior hemianopsia as an early symptom of Heidenhain type Creutzfeldt-Jakob disease].

BACKGROUND: The Heidenhain variant is a subtype of Creutzfeldt-Jakob disease (CJD) where visual symptoms are leading. HISTORY AND SIGNS: We report on a 60-year-old woman who developed within a few weeks bilateral inferior hemianopsia. Morphological findings of the eyes were normal. Neurological examination and cerebral CT/MRI were normal too. P 100 latency of visual evoked potentials (VEP) of both eyes, however, was delayed. OUTCOME: During the course of the disease visual field narrowed progressively and 3 months after the first symptoms the patient went blind. Only at that time myoclonia, hyperkinesia, and psychiatric symptoms appeared. Changes of EEG and cerebrospinal fluid were suggestive of Creutzfeldt-Jakob disease (CJD). The patient died after 5 1/2 months and diagnosis was confirmed neuropathologically with mainly occipital spongiform encephalopathy. CONCLUSION: This case illustrates the diagnostic difficulties of the Heidenhain type of CJD and demonstrates that in patients with progressive visual field defects without morphological abnormalities of the eyes or radiological abnormalities of the brain CJD should be considered. It should be looked out for additional neurological (especially extrapyramidal) and psychiatric symptoms.

Creutzfeldt-Jakob Syndrome↗
PubMed1988

[Homonymous hemianopsia in brain tumors].

Homonymous hemianopsia may be caused by tumors in the region of the optic tract, the lateral geniculate body, the optic radiation, and the visual cortex. Tumors are responsible for about two-thirds of the temporal lesions and about one-half to one-third of the parietal and occipital lesions. With brain tumors a chronological sequence of two groups of signs and symptoms is the rule: first the focal symptoms corresponding to the tumor lesion in a defined cerebral area, later the distant effects of the increasing volume of the tumor, which lead to the general signs of increased intracranial pressure. The different types of homonymous hemianopia in tumor lesions along the suprachiasmatic pathway (optic tract, lateral geniculate body, temporal lobe, parietal lobe, occipital lobe) are described and discussed. The general neurological signs and symptoms are briefly reviewed. Demonstration of important cerebral diagnostic examination methods (plain X-ray, electroencephalogram, computer tomogram, nuclear magnetic resonance, angiography). Differential diagnosis of brain tumors (hematomas, abscesses, granulomas, parasites etc.).

Brain Mapping↗
PubMed1988

[Rehabilitation of the hemianopsia patient from the viewpoint of the ergotherapist].

Hemianopsia, above all if it is associated with other neuropsychological deficits (neglect, disturbances of spatial orientation) is very disturbing for the patient in daily life. The patient has difficulty dressing, exhibits poor spatial orientation, has difficulty construing spatial relations or reading. Ergotherapy tries to combat all these disorders. There are various methods of treatment at the ergotherapist's disposal: activities of everyday life, such as self-help and household training, functional games, craft skills and neurotraining, which aims in particular at improving intellectual function. In a well-protected environment the patient learns to judge his or her capabilities correctly once again and to make the best of his or her strength or weaknesses in daily life.

Activities of Daily Living↗
PubMed1988

[Fresnel prisms--their value in the rehabilitation of homonymous hemianopsias].

The use of press-on Fresnel prisms is described as a simple inexpensive technique to rehabilitate patients with homonymous hemianopsia. The optical principle of prismatic displacement from the blind to the seeing fields is detailed herein. Forty-one patients were evaluated over a 10 year period. Twenty per cent benefited from the prism. Many of those who found limited or little value from their use expressed appreciation that something had been tried in order to improve visual function. Those patients with good acuity and an otherwise normal neurological status are the best candidates. Proper motivation and instruction are essential.

Aged↗
PubMed1980

[Bilateral inferior hemianopsia (author's transl)].

Simultaneous bilateral altitudinal hemianopsia in ischemic optic nerve lesions nearly always involves the lower halves of the visual fields. As regards pathogenesis, systemic hemodynamic disturbance is a prerequisite. In addition local predisposing factors must exist which cause infarction to occur at the characteristic site, i.e., the upper optic disk and the adjacent retrolaminar region. The theories dealing with this problem are reviewed. In this connection a rather unusual case is described.

Adult↗
PubMed1980

Temporal lobe epilepsy and hemianopsia in childhood of perinatal origin. An overlooked and potentially treatable disease? Report of two cases, one with a demonstrable etiology.

Two children with a history of traumatic delivery developed severe temporal lobe epilepsy starting at age 4 and 10 respectively. The main neurological finding was total homonymous hemianopsia. The CAT Scan showed a large localised hypodensity in the occipital region on one side consistent with an old infarction in that region. A similar clinical syndrome was described in 1974 by Remillard as temporal lobe epilepsy and perinatal occlusion of the posterior cerebral artery (PCA). In one of our cases, the clinical course suggested that vascular occlusion in the PCA territory resulted from temporal lobe herniation related to a subdural hematoma at birth. It is proposed that this mechanism may apply to some instances of that condition. This clinical syndrome is now increasingly diagnosed as a large number of epileptics are now submitted to CAT. The diagnosis can be delayed until a seizure disorder develops because of the frequent absence of obvious neuromotor signs or visual complaints in the first years of life. Early recognition of this particular type of neonatal cerebral injury could possibly lead to prevention or early treatment.

Epilepsy, Temporal Lobe↗
PubMed2000

Visual loss and central venous catheterization: cortical blindness and hemianopsia after inadvertent subclavian artery entry.

A case of presumed embolic transient ischemic episodes and multifocal infarcts to the occipital and parietal cortices and the cerebellum of a young woman with ulcerative colitis is reported. These episodes were manifested by multifocal neurologic deficits including cortical blindness, visual hallucinations, and homonymous hemianopsia. They correlated with parenteral nutrition via a central line, presumed venous, but found to be in the subclavian artery. The complications of central venous lines are reviewed. The need for attention to neighborhood structures and unexpected symptoms, in view of the less well-recognized arterial embolic complications is emphasized.

Adult↗