Hemianopia Research Articles

Clinical characteristics and prognostic factors analysis of ethambutol-induced optic neuropathy

Objective To observe the clinical features and visual prognostic factors of ethambutol-induced optic neuropathy (EON). Methods A cohort study. Twenty-four inpatients (46 eyes) identified as EON in Neuro-Ophthalmology Department of Chinese PLA General Hospital from January 2014 to December 2017 were enrolled, including 14 males (26 eyes) and 10 females (20 eyes) with a ratio of 1.4/1 male/female. The average age was 42.79±15.12 years and the average weight was 62.46±12.31 kg. The average time duration between oral administration of ethambutol and occurrence of EON was 9.94±16.49 months. The average time of ethambutol duration was 7.06±11.68 months, with an average accumulative dose of 156.7±1 779.0 g and the average daily dose of 15.07±8.95 mg/(kg·d). All patients were tested with visual acuity, fundus photos, colour vision, OCT, visual field, VEP, orbital MRI and the gene of OPA1 and mitochondrial deoxyribonucleic acid(mtDNA). All the patients accepted drug withdrawal immediately after diagnosis, and were given the treatment of systemic nerve nutrition and improvement of microcirculation for 2 weeks. The time of follow-up was more than 12 months. According to whether the visual acuity (VA) in any of eyes was over than 0.1 at the last follow- up, all the patients were divided into two groups: the bad VA group (VA less than or equal to 0.1) and the better VA group (VA over than 0.1) group. The χ2 test and Fisher's exact probabilistic method test were used to compare the counting data between groups, and the Wlincox rank sum test was used to compare the measurement data. Multiple factors of VA outcome between the patients with bad or better va were analyzed by logistic regression. Results Thirty eyes (65.2%) had VA less than or equal to 0.1 and 5 eyes (10.9%) had VA over than 0.5 at EON onset. The VA of the rest 11 eyes (23.9%) was higher than 0.1 and lower than 0.5. At the last follow- up, 20 eyes (43.5%) had VA less than or equal to 0.1 and 9 eyes (19.6%) had VA over than 0.5, the VA of the rest 17 eyes (36.9%) was higher than 0.1 and lower than 0.5. Fundus examination revealed 7 eyes (15.3%) with optic disc edema. OCT revealed significant loss of the retinal nerve fiber layer (RNFL) in the affected eyes, mainly in the temporal RNFL of the optic disc. All patients had dyschromasia, mainly in distinguishing the color of red and green. The types of visual field defect was as following: central dark spot (52.2%), diffuse visual acuity decreased (30.4%), temporal hemianopsia (17.4%). Orbital MRI revealed that 12/24 (50.0%) patients had T2 lesions with T1 enhancement in 6/24 patients (25.0%). Genetic test showed that 4 patients (16.7%) had gene mutation. Among them, there were 2 patients with OPA1 mutation, 1 with mtDNA 14340 point mutation and 1 with the mtDNA 11778 point mutation. Thirteen patients showed better VA outcomes (over than 0.1) while 11 showed bad VA outcomes after discontinuation of ethambutol. Between the better VA group and the bad VA group, there were statistically significant differences in the daily dose of ethambutol and gene mutation(P=0.031, 0.023). The daily dose was related to visual prognosis of EON while only the daily dose of more than 18 mg/(kg·d) may lead to bad VA outcomes according to the logistic analysis (95% CI 0.007-0.736, OR=0.069, P=0.027). Conclusions EON may have OPA1 and mtDNA mutation with more bilateral eyes involved and less optic edema, which about 43.5% of the patients showed irreversible visual impact. The daily dose of ethambutol is related to the vision recovery. Key words: Ethambutol/adverse effects; Optic nerve diseases; Disease attributes; Prognosis; Root cause analysis

Left Pan-Hippocampal Low Grade Glioma-2-Stage Transsylvian Transventricular and Paramedian Supracerebellar Transtentorial Approaches: 2-Dimensional Operative Video.

The surgical goal for low-grade gliomas (LGGs) is to maximize resection while minimizing morbidity. Pan-hippocampal LGGs extend from the hippocampal head to the hippocampal tail, and involve the parahippocampal gyrus and uncus. Given their anteroposterior extension, they cannot be completely removed with 1 single approach, requiring a 2-stage front-to-back operation. In this video, we present the case of a 52-yr-old man with new onset of generalized seizures and a dominant-side, nonenhancing, pan-hippocampal infiltrative lesion compatible with a low-grade glioma. Preoperative high-definition fiber tractography (HDFT) showed the spatial relationship of the tumor with surrounding fiber tracts, such as the arcuate, inferior fronto-occipital, and middle longitudinal fascicles, and optic radiations. Surgical resection was planned in 2 separate stages. The first stage consisted of a transsylvian transinferior insular sulcus approach to the extra- and intraventricular aspects of the uncohippocampal region. The entire anterior and middle portions of the tumor were successfully removed with minimal morbidity, including transient naming difficulties and permanent superior quadrantanopia. Postoperative HDFT showed preservation of all fiber tracts, except for a portion of Meyer's loop and the inferior-most aspect of the inferior fronto-occipital fascicle. The second stage was completed 8 wk later and consisted of a paramedian supracerebellar-transtentorial approach on sitting position. The posterior portion of the tumor was entirely removed to achieve a complete macroscopic tumor resection. The final diagnosis was IDH1-positive LGG. Pan-hippocampal tumors remain a surgical challenge but accurate knowledge of surgical neuroanatomy and surgical approaches facilitates their safe and effective treatment. The patient signed an informed consent including the use of photographic and video material for educational or academic purposes.

Awake Surgery for Gliomas within the Right Inferior Parietal Lobule: New Insights into the Functional Connectivity Gained from Stimulation Mapping and Surgical Implications.

Little is known about the functional role of the white matter connections running within and around the right inferior parietal lobule (IPL). We used direct electrostimulation during awake surgery to investigate this connectivity and to avoid permanent deficit after resection for right IPL gliomas. We reviewed patients who underwent awake mapping for a glioma involving the right IPL. Resection was achieved up to functional corticosubcortical boundaries detected by electrostimulation. Results of the intraoperative mapping were confronted to preoperative and postoperative magnetic resonance imaging to perform anatomofunctional correlations. Fourteen consecutive patients were enrolled (9 men; mean age, 44 years). Cortically, the resection was limited anteriorly by the retrocentral somatosensory area (11 patients) or by the precentral motor cortex (3 patients). Subcortically, the thalamocortical pathways were identified anteriorly in all patients. Articulatory disturbances were elicited anteriorly and laterally (6 patients) corresponding to the superior longitudinal fasciculus part III. Deeper and superiorly, stimulating the superior longitudinal fasciculus part II or the arcuate fasciculus induced spatial disorders (6 patients). More laterally and posteriorly, disrupting the inferior fronto-occipital fasciculus induced nonverbal semantic disorders (7 patients). Six patients had visual deficits while the optic radiations were stimulated. A total or subtotal resection was achieved in all patients but one. There were no permanent impairments, except an expected left superior quadrantanopia in 4 patients. This is the first surgical series focusing on right IPL gliomas. The complex functional connectivity detected within and around this region fully supports the use of intraoperative multimodal functional mapping for optimizing outcomes.

A comparison between Humphrey and frequency doubling perimetry for chiasmal visual field defects.

To evaluate and compare the diagnostic ability of frequency doubling technology perimetry (FDT) with standard automated perimetry (SAP) using Humphrey Field Analyser for the detection of visual field defects produced by chiasmal lesions. Fifteen patients with documented chiasmal disease and previously diagnosed of bitemporal hemianopia with Humphrey perimetry were prospectively evaluated. All of them underwent a new SAP (SITA 24-2) followed by FDT tests (C-20 threshold). Diagnostic criteria for hemianopia were established according to the total deviation plot and the threshold values of FDT. A patient was diagnosed with hemianopia if one or both criteria were met. Based on these criteria, FDT sensitivity was calculated. Testing time and global indexes for both perimetric strategies were compared. The sensitivity of FDT was 75.0% (18 out of 24 eyes); the criterion based on threshold values was met more often (70.83%) than the criterion based on the total deviation plot (50.0%). Linear correlation was better for the external column than for the internal column of the visual field. Testing time with FDT was 122.16 seconds shorter than with SAP (p<0.001). The mean value for mean deviation (MD) was -13.62 dB (SD 6.88) for SAP and -8.83 dB (SD 5.94) for FDT (p<0.001). Compared with standard automatic perimetry, FDT has a low sensitivity for detecting temporal hemianopias and also has more difficulty in defining the vertical limits of the defects. There f o re, it does not appear to be an adequate method for the detection of chiasmal visual field defects.

Hemimegalencephaly: Seizure outcome in an infant after hemispherectomy

Isolated hemimegalencephaly (iHME) is a rare form of congenital malformation of cortical development characterized by enlargement of all or part of one cerebral hemisphere. It typically presents with intractable seizures, developmental delay, contralateral hemiparesis, and hemianopia. We report a case of an 18-month-old girl who presented first with focal seizures at tenth day of life, with no other physical or behavioral abnormality. Initial EEG showed excessive sharp EEG transients more over the right hemisphere; repeated EEG showed spikes, polyspikes, sharps, and slow wave discharges predominately over the right hemisphere. MRI of the brain showed asymmetric enlargement of the right cerebral hemisphere, suggestive of hemimegalencephaly. Initial treatment with antiepileptic drugs (AEDs) was successful in controlling her seizures, but later on the seizures became intractable even on polytherapy of AEDs; finally, functional hemispherectomy was performed and she became seizure free. Identification of this and similar cases of iHME can help us to better understand this disorder and eventually to provide better treatment options for it.

Visual field defects after temporal lobe resection for epilepsy

PurposeTo determine visual field defects (VFDs) using methods of varying complexity and compare results with subjective symptoms in a population of newly operated temporal lobe epilepsy patients. MethodsForty patients were included in the study. Two patients failed to perform VFD testing. Humphrey Field Analyzer (HFA) perimetry was used as the gold standard test to detect VFDs. All patients performed a web-based visual field test called Damato Multifixation Campimetry Online (DMCO). A bedside confrontation visual field examination ad modum Donders was extracted from the medical records in 27/38 patients. All participants had a consultation by an ophthalmologist. A questionnaire described the subjective complaints. ReultsA VFD in the upper quadrant was demonstrated with HFA in 29 (76%) of the 38 patients after surgery. In 27 patients tested ad modum Donders, the sensitivity of detecting a VFD was 13%. Eight patients (21%) had a severe VFD similar to a quadrant anopia, thus, questioning their permission to drive a car. In this group of patients, a VFD was demonstrated in one of five (sensitivity=20%) ad modum Donders and in seven of eight (sensitivity=88%) with DMCO. Subjective symptoms were only reported by 28% of the patients with a VFD and in two of eight (sensitivity=25%) with a severe VFD. Most patients (86%) considered VFD information mandatory. ConclusionVFD continue to be a frequent adverse event after epilepsy surgery in the medial temporal lobe and may affect the permission to drive a car in at least one in five patients. Subjective symptoms and bedside visual field testing ad modum Donders are not sensitive to detect even a severe VFD. Newly developed web-based visual field test methods appear sensitive to detect a severe VFD but perimetry remains the golden standard for determining if visual standards for driving is fulfilled. Patients consider VFD information as mandatory.

Complications After Surgery for Mesial Temporal Lobe Epilepsy Associated with Hippocampal Sclerosis.

Hippocampal sclerosis is the most common cause of drug-resistant epilepsy amenable for surgical treatment and seizure control. This study aimed to analyze morbidities related to surgery of mesial temporal lobe epilepsy associated with hippocampal sclerosis and to identify possible risk factors for complications. A retrospective analysis of postoperative complications was made for 389 operations performed between 1990 and 2015 on patients aged 15-67 years (mean 36.8). Three surgical approaches were used: anterior temporal lobectomy (ATL) (n= 209), transcortical selective amygdalohippocampectomy (SAH) (n= 144), and transsylvian SAH (n= 36). Complications were classified as minor or major if there was a neurologic impairment or if further surgical or medical treatment was necessary. Complications followed 15.4% of operations. They were classed as major for 4.1% of patients, but there were no mortalities. Persistent neurologic deficits occurred in 0.5% of patients. In 3 cases (0.8%) additional surgery was necessary to treat an intracranial hematoma, a delayed hydrocephalus, and a subdural empyema. Symptomatic visual field defects (VFDs) were frequent and included contralateral superior quadrantanopia (8.2%) or hemianopia (1.3%). Overall complications (P= 0.04) and symptomatic VFDs (P= 0.04) were most frequent in operations on men. Major complications occurred most often with the ATL surgical approach than with transcortical SAH (P= 0.03). Major complications occur rarely after mesial temporal surgery on epileptic patients. They occur more often following the ATL rather than transcortical SAH approach. Complications tend to be temporary with symptoms of limited duration for surgery performed by experienced teams on carefully selected and evaluated patients.

Fluctuating Neurologic Symptoms in a Patient With Brain Lesion

There is a broad spectrum of focal brain lesion in humans. They include primary brain tumor, non-neoplastic cysts, metastatic lesion, stroke, vascular malformations, aneurysm, inflammatory lesions and multiple sclerosis. The case was a 45-year-old female with fluctuating visual problem, ataxia, right upper limbs weakness, and transient amnesia who was referred to the neurologist. She was alert and under treatment from 10 years before by anti-convulsive drug for seizure with unknown etiology. Physical examination revealed ataxic gate, left-sided homonymous lower quadrantanopia and loss of venous pulse in ophthalmoscopy; there were no other pathological findings. Primary brain imaging (axial brain CT scan) was performed which showed a suspected lesion in right-sided parietooccipital area. Brain MRI and CT angiography revealed a heterogeneous lesion in right-sided parietooccipital area without edema and a mass in the form of vascular malformation. Because of the size and location of the lesion, it seemed inoperable. Treatment plan included serial visit and imaging to follow the progress of lesion and probable complications such as intralesional hemorrhage and hydrocephalia. J Med Cases. 2017;8(2):67-69 doi: https://doi.org/10.14740/jmc2706w

INHERITED THROMBOPHILIA SECONDARY TO PROTEIN S DEFICIENCY ASSOCIATED WITH ISCHEMIC STROKE. CASE REPORT

Thrombophilia is characterized by an increased tendency to arterial and venous thrombus formation. Inherited thrombophilia can be secondary to protein S deficiency. Concomitant use of oral contraceptive pills increases the risk of venous thromboembolism and arterial thrombosis. We report a case of a 34-year-old female who used oral contraceptive pills for many years, who developed acute ischemic stroke of right occipital lobe with secondary left superior homonymous quadrantanopia. We have run several tests to establish the ischemic stroke etiology: unenhanced brain and cervical spine computed tomography, brain magnetic resonance imaging and magnetic resonance angiography (including MR venography), computed tomographic angiography, echocardiography, extracranial duplex ultrasound and laboratory data (including thrombophilia testing). The laboratory investigations confirmed that the ischemic stroke of our patient resulted from a severe inherited thrombophilia secondary to protein S deficiency.

The Damato Multifixation Campimetry Online (DMCO) – A possible visual field test to detect neurological visual field defects

PurposeThe aim of the present study is to determine the ability of DMCO to detect visual field (VF) loss after epilepsy surgery and to determine the risk of visual field defects related to the operation.MethodsSixty patients will be tested by DMCO and Humphrey VF Analyzer (HFA). The patients will get a full eye examination to exclude eye diseases. A questionnaire will determine the subjective claims from the patients.Results16 DT Standard tests have been performed on ten eyes. HFA found that two patients had an almost complete quadrant anopsia, two had a smaller degree of quadrant anopsia, and one had no VF loss. DMCO detected the VF defect in the two patients with almost complete quadrant anopsia and not in the patients with the smaller VF loss. None of the patients perceived their VF loss before the test.ConclusionsThe preliminary results indicate an eighty percent risk of VF loss after epilepsy surgery. Our study indicates that DMCO may be a useful tool to detect neurological unrecognized VF losses.

Microsurgical treatment of lateral ventricular meningiomas

Objective To investigate the effects of the selection of surgical approaches of lateral ventricular meningiomas and microsurgical skills on postoperative efficacy and complication rate. Methods The clinical data of 47 patients with lateral ventricular meningioma operated at the Department of Neurosurgery, Tianjin Huanhu Hospital from October 1 2006 to October 1 2014 were analyzed retrospectively. The patients were treated via parietooccipital approach (n=38) and temporal gyrus cortex approach (n=9) according to the different locations and directions of tumors. Thirty-two of them used neuronavigation and 26 used intraoperative ultrasound technology. Results Thirty-eight patients were treated via parietooccipital approach, the tumors of 37 patients were resected totally (Simpson grade Ⅰ), and 1 was resected subtotally (Simpson grade Ⅳ). Nine patients were treated via temporal gyrus approach and their tumors were resected totally. The symptoms of intracranial hypertension of 30 patients were relieved with varying degrees after procedure; the symptoms of hemianopsia of 9 patients were improved after procedure, 2 aggravated, and 1 was a new case; ataxia and other movement disorders of 8 patients were improved; 2 patients underwent ventricle-peritoneal shunt and puncture drainage respectively because of hydrocephalus. In this group, 29 patients were followed up for 3 months to 8 years (mean 47 months) after procedure. Two patients had recurrence and were reoperated. Conclusions Lateral ventricle meningioma prefers surgical treatment. Choosing appropriate surgical approaches with the help of neuronavigation and intraoperative ultrasound and other techniques may decrease the postoperative complication rate and achieve good operation effect. Key words: Meningioma; Lateral ventricle; Approach, surgical; Complication; Neuronavigation

Microsurgical resection for lateral ventricular meningiomas with neuronavigation and tubular retractor system

Objective To study the microsurgical modality for lateral ventricular meningiomas with neuronavigation and tubular retractor system and evaluate its long term outcome. Methods The clinical and follow-up data of 23 lateral ventricular meningioma patients during the past 3 years were collected for a retrospective analysis in our center. 12 patients used neuronavigation and tubular brain retractor system, 11 patients received traditional manual measurement anatomic landmarks with traditional brain retractor. The tumor resection extent, overall survival, recurrence, operation exposure, operation trauma, peri-operative complications and? post-operative quality of life were compared between two groups. Results The total tumor resection was achieved at 100% in both groups and the perioperative death or tumor recurrence within the follow-up period was not observed in both groups. The overall survival rate achieved 100%. Neuronavigation combined with tubular brain retractor technology did not increase the overall complications(P=0.414), nor decrease the operative field exposure(P=0.667). Its utility did not extend the operation time(P=0.695), but reduced the occurrence of aphasia and hemianopia after operation and significantly shortened the length of incision(P=0.034), the size of craniotomy(P=0.021) , the cortical incision length(P=0.001)and the days of hospitalization(P=0.037). Importantly, neuronavigation with tubular brain retractor system could significantly improve the postoperative quality of life for lateral ventricular meningioma patients(KPS, P=0.029). Conclusions Neuronavigation and tubular brain retractor system used in microsurgical resection of lateral ventricular meningioma doesn't decrease the total tumor resection and the operation exposure, but reduced intra-operative brain trauma and peri-operation complications. For the improvement of post-operative quality of life, it was suitable for lateral ventricular meningiomas. Key words: Neuronavigation; Lateral ventricl; Meningioma; Microsurgery

A Rare Complication After Conventional Coronary Angiography: Left Homonymous Hemianopia

Konvansiyonel Koroner Anjiografi Sonrasi Nadir Bir Komplikasyon: Sol homonim Hemianopsi Ihsan Alur, Veli Citisli, Gokhan Pekel, Tevfik Gunes, Gokhan Yigit Tanrisever, Gokhan Onem Pamukkale Universitesi Tip Fakultesi, Kalp Ve Damar Cerrahisi Anabilim Dali, Denizli Pamukkale Universitesi Tip Fakultesi, Beyin Cerrahisi Anabilim Dali, Denizli Pamukkale Universitesi Tip Fakultesi, Goz Hastaliklari Anabilim Dali, Denizli

Analysis of the surgical strategy for the treatment of pineal region tumors

To evaluate and explore the optimal surgical strategy for the normalized treatment of pineal region tumors. From September 2007 to February 2012, 43 patients were treated in Chinese People's Liberation Army General Hospital, including 30 male and 14 female patients, with pineal region tumors and non-communicating hydrocephalus were enrolled, who were 1-52 years old, mean age was (27 ± 4) years. The clinical records, treatment strategy, and prognosis were retrospectively analyzed. All the patients routinely underwent endoscopic third ventriculostomy (ETV) and tumor biopsy as the initial treatment. Twenty-seven cases (62.8%, pure endoscopic group) with histological diagnosis of germinoma (23 cases) or pineoblastoma (4 cases) were treated with chemotherapy with/without radiation therapy after ETV. The rest 16 cases (37.2%, craniotomy group) with histological diagnosis of non-germinoma and non-pineoblastoma (5 astrocytomas, 4 pineocytomas, 4 teratomas, 2 ependymomas, and 1 pineopappiloma) had craniotomy and tumor resection after ETV. All the cases had routine follow-up at 1, 3, and 6 months after the final surgery. The clinical, imaging, and tumor markers analysis were routinely examined at follow-up. In the pure endoscopic group, 1 case had intra-ventricular hemorrhage after ETV, followed by external ventricular drainage and recovered after 1 week. Endoscopic procedure related short-term ( < 3 months) complication rate was 2.3% (1/43), while long-term morbidity was 0. All cases in the pure endoscopic group had chemotherapy with/without radiation therapy. Long-term follow-up results showed that all cases were cured or had progression free survival (PFS). In the craniotomy group, 2 cases (2/16) developed intra-cranial hemorrhage after surgery, and had to be operated again for hematoma evacuation. In the craniotomy group, the short-term ( < 3 months) morbidity rate was 6/16. At 3 months follow-up, 1 case still had homonymous hemianopia, which made the long-term morbidity rate was 1/16. For pineal region tumors with non-communicating hydrocephalus, simultaneous ETV with tumor biopsy can be the most favorable initial diagnostic and therapeutic treatment. Second-stage treatment (chemotherapy, radiation therapy, or craniotomy with tumor resection) can be selected according to the histological diagnosis.

Awake mapping for low-grade gliomas involving the left sagittal stratum: anatomofunctional and surgical considerations

Preserving function while optimizing the extent of resection is the main goal in surgery for diffuse low-grade glioma (DLGG). This is particularly relevant for DLGG involving the sagittal stratum (SS), where damage can have severe consequences. Indeed, this structure is a major crossroad in which several important fascicles run. Thus, its complex functional anatomy is still poorly understood. Subcortical electrical stimulation during awake surgery provides a unique opportunity to investigate white matter pathways. This study reports the findings on anatomofunctional correlations evoked by stimulation during resection for gliomas involving the left SS. Surgical outcomes are also detailed. The authors performed a review of patients who underwent awake surgery for histopathologically confirmed WHO Grade II glioma involving the left SS in the neurosurgery department between August 2008 and August 2012. Information regarding clinicoradiological features, surgical procedures, and outcomes was collected and analyzed. Intraoperative electrostimulation was used to map the eloquent structures within the SS. Eight consecutive patients were included in this study. There were 6 men and 2 women, whose mean age was 41.7 years (range 32-61 years). Diagnosis was made because of seizures in 7 cases and slight language disorders in 1 case. After cortical mapping, subcortical stimulation detected functional fibers running in the SS in all patients: semantic paraphasia was generated by stimulating the inferior frontooccipital fascicle in 8 cases; alexia was elicited by stimulating the inferior longitudinal fascicle in 3 cases; visual disorders were induced by stimulating the optic radiations in 5 cases. Moreover, in front of the SS, phonemic paraphasia was evoked by stimulating the temporal part of the arcuate fascicle in 5 patients. The resection was stopped according to these functional limits in the 8 patients. After a transient postsurgical worsening, all patients recovered to normal results on examination, except for the persistence of a right superior quadrantanopia in 5 cases, with no consequences for quality of life. The 8 patients returned to a normal social and professional life. Total or subtotal resection was achieved in all cases but one. The authors suggest that the use of intrasurgical electrical mapping of the white matter pathways in awake patients opens the door to extensive resection of DLGG within the left SS while preserving the quality of life. Further anatomical, clinical, radiological, and electrophysiological studies are needed for a better understanding of the functional anatomy of this complex region.

Low vision rehabilitation : skills for occupational therapists

Many older people referred to occupational therapy may experience sight loss, yet, in the presence of other disability, it is commonly overlooked by health professionals (Horowitz 2004). Sight loss can result in significant difficulty with activities of daily living (Dahlin Ivanoff et al 1998) and can be very challenging, particularly for older people who also experience other agerelated disability (Colenbrander & Fletcher, 1995). Low vision rehabilitation includes relatively simple techniques that, if used correctly, can enable the individual to make best use of remaining vision. Incorporating low vision rehabilitation techniques into occupational therapy can enable clients to perform occupations and enhance quality of life (Scheiman et al 2006). Workshop outline: Specific approaches used in low vision rehabilitation will be explored, including: • an introduction to low vision aids; • correct use and ergonomic positioning of low vision aids; • task lighting; • eccentric fixation training, a technique for central vision loss; • strategies to help homonymous hemianopia and additional cognitive or perceptual complications including visual neglect and visual overload; • management of disability glare and/or poor contrast sensitivity. Workshop outcomes: This workshop, jointly facilitated by a low vision therapist and an occupational therapist, will provide both knowledge and practical skills. These can be used to augment current practice, enable appropriate early referral to specific services if appropriate and can reduce the risk of the myriad negative outcomes associated with sight loss for older people (Scheiman et al 2006).

Vision field analysis of patients with brain trauma

Objective To analyze the visual field of patients with brain trauma in our department in the recent 4 years.Methods Visual field data of patients with brain trauma from September 2008 to September 2012 was collected and analyzed.Results In 57 patients,44 patients (77.2％) were with normal visual field,and 13 patients (22.8％) were with abnormal visual field.In 13 patients with abnormal visual field,6 cases (46.1％) were with unilateral total blindness because of optic nerve damage,4 cases (30.8％) was with bilateral enlarged physiological blind spot because of multiple brain contusion and laceration,2 cases (15.4％) were with bilateral homonymous hemianopia and macular sparing because of occipital lobe damage,and 1 case (7.7％) was with bilateral inferior hemianopsia because of parietal lobe damage.Conclusion Brain trauma which damages the optic pathway can cause the visual field change,and the visual field shape depends on the damage location and size.Among the brain trauma that causes visual field loss,optic nerve damage is more common.In a word,visual field examination has important guiding significance in the diagnosis and therapy for patients with brain trauma. Key words: Brain ; Trauma ; Visual field

PCA Infarction With Its Cognitive Findings: More Than Hemianopia

PCA Infarction With Its Cognitive Findings: More Than Hemianopia

Concentric visual field defect related to spontaneous intracranial hypotension

Spontaneous intracranial hypotension (SIH) is a rare syndrome characterized by postural headache associated with a low cerebrospinal fluid pressure in the absence of dural puncture or penetrating trauma. Cranial magnetic resonance imaging (MRI) typically shows diffuse pachymeningeal gadolinium enhancement, subdural fluid collections, prominence of cerebral venous sinuses and brain descent. Visual signs and symptoms have been described infrequently in patients with SIH. These include third or sixth nerve palsy, superior nasal quadrantanopia and temporal hemianopia. We report a 34 year-old woman who presented with a two-year history of orthostatic headache, dizziness and transient visual obscurations. Campimetry showed a bilateral concentric visual field defect. She also described that intermittently a transparent fluid leaked out of her nose. She had no past history of trauma, sinus surgery or intracranial surgery. Cranial MRI was normal. Neuro-ophthalmological examination ruled out any other causes of concentric visual field defects. Lumbar puncture showed a cerebrospinal fluid (CSF) opening pressure of 9 cm H2O. Radioisotope cisternography suggested a dural leak at cribiform plate. The cribiform plate region was repaired endoscopically with improvement of all symptoms. One year later she remains asymptomatic and the visual field defects have improved.

Localized bi-nasal macular edema in optic chiasmal syndrome

A 28-year-old healthy male complaining of vision loss in his right eye was discovered to have localized bi-nasal macular edema in the presence of a pituitary adenoma. The presence of a junctional scotoma composed by a central scotoma in the right eye associated with superior temporal quadrantanopia in the fellow eye was seen. The pattern detected in the visual field suggested the presence of an expansive mass at the level of the optic chiasm. Optical coherence tomography findings also revealed subtle macular thickness beyond normal in the superior and nasal quadrants of both maculae. This report illustrates the importance of suspecting a pituitary adenoma in the light of uncharacteristic retinal alterations.