Traumatic homonymous hemianopia

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The goal of this study was to describe the characteristics of patients with homonymous hemianopia (HH) from traumatic brain injury (TBI) seen in the neuro-ophthalmology unit at Emory University between 1989 and 2004. Only patients with a history of TBI, who had detailed clinical information and results of neuroimaging, were included in this study. Demographic characteristics, clinical features, types of visual field defects, location of lesion, and evolution of visual field defects were recorded. Of the 880 patients with homonymous hemianopia included in the study, 103 patients (112 with HH) had a TBI [74 men and 29 women, mean age 30.7 (standard deviation [SD] 15.3) years]. Median time from injury to initial visual field testing was 5 (range, 0.5 to 360) months. In all, 64 patients (57.1%) sustained injuries that were motor vehicle-related; 19 (17%) violence-related; 17 (15.2%) due to falls; and 12 (10.7%) because of other blunt head trauma. Visual field defects included complete HH in 44 patients (39.3%) and incomplete HH in 68 patients (60.7%). The lesion was occipital in 14 patients (12.5%), associated with optic radiation in 26 (23.2%) and the optic tract in 12 (10.7%), and multiple in 60 (53.6%). The authors conclude that most cases of HH from TBI were motor vehicle-related. Patients were younger, more often male, and had multiple brain lesions more often than patients with HH from causes other than TBI. A median delay of five months was observed before the documentation of the HH, which may have a major effect on the success of rehabilitation and driving training in these young patients.—Valérie Biousse