Clinical applications of visual evoked potentials for detection of chiasmal and postchiasmal lesions (author's transl)

Abstract

Visual evoked potentials (VEP) were recorded in 18 patients with pathologic processes confirmed by computerized tomography in the chiasmal (n = 9) and parietooccipital region (n = 9). Reactions from the right and left hemisphere could be recorded separately in spite of using a simple one-channel apparatus and electrodes only at Oz and Cz. In 17 cases changes of the VEP provided information concerning the localization and extension of the lesion. In chiasmal processes we found a prolongation of monocular latencies, and a delayed or extinguished reaction to half-field stimulation from temporal retinal areas. However, the VEP was often pathologic for half-field stimulation of the nasal hemiretina. Pathologic VEPs were not always accompanied by visual field defects. In contrary to patients with chiasmal processes no pathologic reaction could be found to full-field stimulation in parieto-occipital lesions. Only when the affected hemisphere was stimulated selectively were diminution of amplitudes, prolongation of latencies, or extinguished responses observed. The VEP changes were uniform despite the cause of the lesion (tumor, ischemia). In chiasmal and parieto-occipital processes the VEP supplements computerized tomography by detecting deficits in function. This method appears suitable for monitoring the course of disease before and after neurosurgery.