Occipital Lobe Abscess Causing Homonymous Hemianopsia After a Dental Procedure

Abstract

Background: A homonymous hemianopsia visual field defect is defined as vision loss on the same side of the vertical midline in both eyes. Although the vast majority are caused by an ischemic stroke, other neurologic etiologies must be considered and ruled out. This case highlights the importance of a rapid and thorough investigation of a patient’s symptoms using both clinical examination and imaging to reduce the risk of permanent complications and potential fatality. Case Report: A 67-year-old Caucasian male presented to the eye clinic with sudden onset reduced peripheral vision to his right side in both eyes. Entering visual acuities were 20/40 OD and 20/60 OS. Humphrey visual field (HVF) testing confirmed a complete right homonymous hemianopsia. Magnetic resonance imaging (MRI) revealed a large, left occipital lobe intracranial mass. Neurosurgical intervention was necessary to confirm the diagnosis of a brain abscess, thought to be related to a prior dental procedure with tooth extraction. Conclusion: A brain abscess is a focal area of necrosis within the brain parenchyma that typically results from an infectious process. Though rare, the condition has potentially devastating neurologic complications which can be mitigated with early detection and treatment. In this case, the abscess caused a right homonymous hemianopsia field defect, which prompted his urgent request for an appointment with the eye clinic.