Cases Of Homonymous Hemianopia Research Articles

Homonymous hemianopia: An unusual presentation of vitamin B 12 deficiency

A 24 years male presented with a headache for one year, recent memory loss and loss of left hemifield of vision for three months. Upon examination, visual acuity was found to be 20/20 in both eyes. Automated perimetry revealed left homonymous hemianopia with sparing of the macula. Right thalamic infarct and subacute infarct in the territory of the right posterior cerebral artery (PCA) were the findings on CT scan. Except for decreased vitamin B12 level and increased homocysteine level in serum, rest of the serological, biochemical, hormonal and immunological investigations were within normal limits. MRI of the brain showed right PCA infarct and few ischemic foci in bilateral periventricular regions. MR Angiogram revealed relatively reduced flow in the right PCA and right vertebral artery. The patient was managed with antiplatelet drugs and supplementation of vitamin B12. Marked improvement was noticed in a headache and memory loss and there was normalization of field defect after 6 months of treatment. Cases of homonymous hemianopia in neuro-ophthalmology are not unusual, but the etiology and course of this case report make an interesting variation. Keywords: Homonymous hemianopia, Vitamin B12 deficiency, Posterior Cerebral artery infarct.

The unilateral occipital transtentorial approach for pineal region meningiomas: a report of 15 cases

In the current study, we reviewed and re-evaluated the experiences of microsurgical management for pineal region meningiomas via the unilateral occipital transtentorial approach (Poppen's approach). Clinical data were obtained on 15 meningiomas of the pineal region, which underwent microsurgery via unilateral Poppen's approach from March 2009 to June 2012. These patients were hospitalized in our department; their data were collected and analyzed retrospectively. The tumors were removed via the right Poppen's approach in 12 cases and left Poppen's approach in 3 cases, and intraoperative external ventricular drainage was performed for hydrocephalus in 3 cases. As a result, gross total resection was achieved in 11 cases, near total resection in 3 cases and subtotal resection in 1 case. All resected tumors were pathologically confirmed. The postoperative complications included two cases of homonymous hemianopia, and deteriorated Parinaud syndrome and diplopia in one case. Ten cases were followed up (range 1–4 years) and no death occurred. On the basis of the existing literature and our experiences, the unilateral Poppen's approach is appropriate for most meningiomas of the pineal region that are small or intermediate in size. However, gross total resection might be difficult via the unilateral Poppen's approach for large-sized meningiomas with much contralateral infratentorial extension due to limited exposure. For these cases, combined supra-infratentorial or bilateral Poppen's approaches are recommended. Preoperative or intraoperative external ventricular drainage can increase tumor exposure and improve microsurgical effects.

Homonymous hemianopia in stroke

Background:Previous reports have suggested that most cases of homonymous hemianopia (HH) are caused by occipital stroke. However, these reports have not always been supported by brain imaging.Methods:We reviewed the medical records of all patients seen in our unit between 1989 and 2004 who had HH do

Traumatic homonymous hemianopia

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

Homonymous Hemianopia in Stroke

Previous reports have suggested that most cases of homonymous hemianopia (HH) are caused by occipital stroke. However, these reports have not always been supported by brain imaging. We reviewed the medical records of all patients seen in our unit between 1989 and 2004 who had HH documented by formal perimetry or confrontation visual fields and had undergone brain imaging. HHs were divided into those caused by stroke and by non-stroke conditions. The clinical and visual field characteristics were compared in the two groups. Among 850 patients with 902 HHs, 629 (69.7%) resulted from stroke, of which 531 (84.4%) were from infarction and 98 (15.6%) from primary intraparenchymal hemorrhage. Non-stroke causes included head trauma (123), brain tumor (102), neurosurgical procedures (22), multiple sclerosis (13), and miscellaneous conditions (13). Occipital lesions most commonly resulted from stroke. The configuration of the HH did not predict where in the retrochiasmal visual pathway the responsible lesion lay. Ischemic stroke causes most HHs from lesions in the occipital lobe that generally do not produce other neurologic manifestations. The configuration of the HH does not predict the location of the lesion within the retrochiasmal visual pathway.

CT in homonymous hemianopia.

Computed tomography (CT) is useful for demonstrating a lesion of the optic pathway, because a slice of the brain almost parallel to the optic pathway can be viewed and the relationship between the optic pathway and the extent of the lesion can be demonstrated. We studied 53 cases of homonymous hemianopia by CT. In 85% of our cases, positive CT findings were obtained. When the lesion was in the occipital lobe, correlation between the size of the lesion and the type of visual field defect was observed.

Three Cases of Homonymous Hemianopia

Three Cases of Homonymous Hemianopia