1/35. Cerebral metastasis presenting with altitudinal field defect.A 75-year-old man presented with a unilateral inferior altitudinal visual field defect and a history of weight loss and night sweats. The acuity in the affected eye was 20/200, otherwise his ocular examination was normal. neuroimaging demonstrated a post-fixed chiasm, with a frontal metastasis compressing the intracerebral portion of the optic nerve. A chest x-ray showed classical cannon ball lesions, secondary to malignant melanoma. This is the first case report of an intracerebral tumor producing an inferior altitudinal field defect.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/35. Retinal red-free light photographs in two congenital conditions: a case of optic hypoplasia and a case of congenital hemianopia.Two patients with congenital anomalies involving the optic pathways are described. The first case presented a unilateral hypoplastic optic nerve as well as an ipsilateral inferior conus and an elevated disc. The second case showed the features of homonymous hemianopia with sparing of the macula and decreased visual acuity on the side of the affected cerebral hemisphere. Red-free photographs were obtained in both cases. The importance of this old-new investigative tool in completing a neuro-ophthalmological study is stressed.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
3/35. Non-ruptured large dorsal internal carotid artery aneurysm presenting with temporal quadrantanopsia.A 63-year-old woman presenting with temporal lower quadrantanopsia of the right eye was found to have a large dorsal internal carotid artery aneurysm. Large dorsal aneurysms of the internal carotid artery are rare. Lateral compression of the optic nerve by the aneurysm might damage the optic nerve at the medial side of the right optic foramen. Direct clipping surgery was performed uneventfully. Since the dome of the aneurysm was buried in the frontal lobe and also attached to the anterior skull base, a careful approach to the aneurysm with removal of the anterior clinoid process and drilling into the planum sphenoidale around the aneurysm dome was needed. The surgical strategy is discussed.- - - - - - - - - - ranking = 2keywords = nerve (Clic here for more details about this article) |
4/35. Bilateral occipital lobe stroke with inferior altitudinal defects.BACKGROUND: Cerebrovascular disease is the most common cause of neurological disability in Western countries. patients who survive cerebrovascular accidents exclusive to the occipital lobe often have no significant neurological deficits other than visual-field loss. Visual-field defects from occipital lobe stroke typically include congruous homonymous hemianopsias or quadranopsias, with or without macular sparing. CASE REPORT: A 61-year-old white man came to us with symptoms of sudden loss of vision and difficulty reading. Visual-field testing revealed a bilateral inferior altitudinal defect with normal optic nerve and fundus appearance in both eyes. On radiological examination, he was found to have had a bioccipital lobe cerebrovascular accident secondary to complete occlusion of the left vertebral artery. An embolic event causing the artery occlusion, in combination with bilaterally compromised cerebellar and posterior cerebral arteries, presumably caused the bilateral stroke. After appropriate medical and neurological consultation, optometric management consisted of maximizing the patient's remaining vision with a prismatic spectacle correction. DISCUSSION/CONCLUSION: patients with infarction exclusive to the occipital lobe typically have no other neurological deficits except visual-field loss and are often easier to manage than patients with infarctions to other areas of the cerebral cortex or multiple infarctions. Visual-field loss from occipital lobe damage can be successfully managed with optical systems and/or visual rehabilitation. Factors related to management include location and extent of visual-field damage, functional visual needs, and both personal and health concerns of the patient. A discussion is presented on cerebrovascular disease, occipital lobe infarction, imaging techniques, and visual rehabilitation.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
5/35. Optic tract compression from dolichoectatic basilar artery.PURPOSE: To report a case of optic tract compression caused by a dolichoectatic basilar artery. DESIGN: Observational case report. methods: A 74-year-old man with progressive loss of vision over 13 years and no other neurologic signs or symptoms was found to have bilateral optic nerve head pallor and a left homonymous hemianopia. RESULTS: magnetic resonance imaging and angiography revealed a severe dolichoectatic basilar artery compressing the right optic tract. CONCLUSION: basilar artery dolichoectasia may rarely cause compression of the optic tract and progressive visual loss.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
6/35. Fourth nerve palsy, homonymous hemianopia, and hemisensory deficit caused by a proximal posterior cerebral artery aneurysm.A 21-year-old man developed an ipsilateral fourth nerve palsy, contralateral hemianopia, and contralateral hemisensory deficit as manifestations of a proximal right posterior cerebral artery aneurysm. This unusual constellation of signs reflects the involvement of the structures that run in the ambient cistern. The fourth nerve palsy and homonymous hemianopia are attributed to compression by the aneurysm. The hemisensory loss is ascribed to compromise of thalamoperforate arteries emanating from a thrombosed portion of the aneurysm.- - - - - - - - - - ranking = 6keywords = nerve (Clic here for more details about this article) |
7/35. Geniculate hemianopias: incongruous visual defects from partial involvement of the lateral geniculate nucleus.Quantitative perimetric studies in 4 patients with involvement of a lateral geniculate nucleus revealed strikingly incongruous defects in the corresponding homonymous fields of vision. The patterns of these hemianopias are analysed and correlated anatomically with established retinotopic projections on the six cellular laminae of the geniculate nucleus. Incongruous wedge-shaped field defects appear to be pathognomonic of focal disease in the dorsal crest of the geniculate nucleus. Other patterns typify lesions of the medical or lateral horns of the nucleus. On theoretical grounds monocular hemianopic defects should result from unilaminar geniculate lesions, but this perimetric sign awaits confirmation. In each case of geniculate disease where the retinal nerve fibre layer has been examined specifically for efidence of retrograde homonymous atrophy, typical hemiretinal signs were found to be present.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
8/35. A long-term observation on a case of epilepsy with occipital continuous spikes.We have reported a 38-year-old female who did not show clinical seizures during continuous spikes in the left occipital area over a period of 18 years. As to the neurological findings, visual disturbance, optic nerve atrophy and right hemianopsia were almost always present. The low density area distributing from the left occipital area to the left temporal one on the CT revealed to be porencephaly. From the clinical findings obtained in this case, the lesion responsible for the occipital continuous spikes could be ascribed to be functional abnormality of the visual pathway connecting the left lateral geniculate body with the left occipital cortex.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
9/35. Partially reversible quadruple sectoranopia caused by vascular steal due to an arteriovenous malformation.BACKGROUND: Lateral, homonymous upper and lower field blind sectors sparing a horizontal zone define quadruple sectoranopia. This rare campimetric deficit involves ischemia or infarction of parts of the lateral geniculate body supplied by the distal anterior choroidal artery. methods: A 41-year-old patient presented with a complaint of blurred vision. visual acuity was 20/20 on both sides. Visual field showed a left quadruple sectoranopia. CT scan, MRI, MRA and conventional angiography showed a right cerebral arteriovenous malformation supplied partly by the right anterior choroidal artery. Partial retinal nerve fiber layer atrophy matched to the campimetric deficit proved that some degree of infarction involved the lateral geniculate body. RESULTS: The arteriovenous malformation was treated with stereotactic radiosurgery. Two years after treatment, the nidus had completely disappeared. The campimetric deficit began improving from 19 months onwards after stereotactic radiosurgery. Twenty-eight months after treatment, the superior defect had completely reversed. CONCLUSIONS: Quadruple sectoranopia involves ischemia or infarction of parts of the lateral geniculate body supplied by the distal anterior choroidal artery. Following radio-induced angioma thrombosis, blood was no longer shunted away from the right lateral geniculate body, whose viable areas resumed their activity. Accordingly, a partial campimetric recovery occurred.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
10/35. Visual field defects in vascular lesions of the lateral geniculate body.Corresponding retinal nerve fibres begin their path in the eyes and end in a single visual cortical cell. Because of this arrangement, lesions in the anterior visual pathway produce incongruent visual field defects and in the posterior pathway congruent field defects. The lateral geniculate body is on the anterior third of the visual pathway. A lesion of this nucleus produces moderately to completely congruent visual field defects. Five patients with ischaemic lesions of the lateral geniculate body are reported. Two patients had a wedge-shaped homonymous hemianopia, two other cases had congruent superior homonymous quadratic defects and the fifth a quadruple sector defect. The lateral geniculate body has a dual blood supply from the anterior choroidal artery (branch from internal carotid artery) and from the lateral choroidal artery (branch from the posterior cerebral artery). A schematic diagram has been devised which shows that a knowledge of the visual field disrupted can identify the arterial system involved.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
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