Editors' note: Mystery Case: Bilateral temporal crescent sparing after cardiac arrest

Abstract

In their Mystery Case, Lindegger et al. presented the unique visual fields of a middle-aged man who complained of tunnel vision 6 months following a cardiac arrest. One challenge to the case was the appearance of the Goldmann perimetry findings, which are nearly the opposite of what would be seen in a lesion affecting the optic chiasm. Instead of having bitemporal loss of vision, the patient had sparing of the most peripheral temporal visual fields with additional sparing of the binocular central fields. Among the 394 survey responses to the case, only 22% of readers correctly localized the lesion to the bilateral calcarine cortex (38% localized the lesion incorrectly to the chiasm). Dr. Rosenberg, a neuro-ophthalmologist, appropriately considers these Goldmann visual field findings controversial, and even contrary to our current understanding of visual pathways. Sparing of the far peripheral nasal fields and crossing of the vertical meridian peripherally would be untenable for bilateral occipital lobe lesions and probably explains why the survey participants had great difficulty localizing the lesion. Lindegger et al. respond that the manual perimetry was performed by an experienced technician, but that some of these atypical visual field findings may have resulted from the fixation losses and cognitive impairment that follows cardiac arrest. In the article “Deep brain stimulation improves restless legs syndrome in patients with Parkinson disease,” Dr. Klepitskaya et al. reported sustained improvement in symptoms of restless legs syndrome (RLS) over 2 years in 22 patients with Parkinson disease (PD) who underwent subthalamic nucleus (STN) deep brain stimulation (DBS), despite a decrease in dopaminergic treatment. Drs. Marques et al. point out that the article misinterpreted the results of their previous study, which showed an emergence of RLS in patients with PD with a higher dose of dopamine agonists and a lower decrease in dopaminergic treatment after STN DBS.