Objective: To describe the characteristics of spontaneous recovery of homonymous hemianopia (HH). Methods: The authors reviewed medical records of all patients with HH confirmed by formal visual field testing and seen...Objective: To describe the characteristics of spontaneous recovery of homonymous hemianopia (HH). Methods: The authors reviewed medical records of all patients with HH confirmed by formal visual field testing and seen in follow-up in their service between 1989 and 2004. Clinical characteristics, causes, neuroradiologic definition of lesion location, final outcome, and evolution of the visual field defects were recorded. The associations among final visual field defect outcome, time from injury, and clinical features were analyzed. Results: A total of 254 patients with 263 HH were included in this study. Spontaneous visual field defect recovery was observed in 101 HH (38.4%). The likelihood of spontaneous recovery decreased with increasing time from injury to initial visual field testing (p = 0.0003). The probability of improvement was related to the time since injury (p = 0.0003) with a 50 to 60%chance of improvement for cases tested within 1 month after injury that decreased to about 20%for cases tested at 6 months after surgery. No other factor was found to correlate with the final outcome of the visual field defects. Improvement after 6 months from injury was mild and usually related to improvement of the underlying disease. Conclusion: Spontaneous improvement of homonymous hemianopia is seen in at least 50%of patients first seen within 1 month of injury. In most cases, the improvement occurs within the first 3 months from injury. Spontaneous improvement after 6 months postinjury should be interpreted with caution as it is most likely related to improvement of the underlying disease or to improvement in the patient’s ability to perform visual field testing reliably.展开更多
Objective: To describe the clinical characteristics and clinical-anatomic correlations of homonymous hemianopia (HH). Background: Homonymous hemianopia impairs visual function and frequently precludes driving. Most kn...Objective: To describe the clinical characteristics and clinical-anatomic correlations of homonymous hemianopia (HH). Background: Homonymous hemianopia impairs visual function and frequently precludes driving. Most knowledge of HH is based on relatively few cases with clinical-anatomic correlations. Methods: The authors reviewed medical records of all patients with HH seen in their service between 1989 and 2004. Demographic characteristics, characteristics of visual field defects, causes of visual field defects, neuroradiologic definition of lesion location, and associated neurologic deficits were recorded. Results: A total of 904 HH were found in 852 patients. A total of 340 HH (37.6%) were complete and 564 HH (62.4%) were incomplete. Homonymous quadrantanopia (264 HH, 29%) was the most common type of incomplete HH, followed by homonymous scotomatous defects (116 HH, 13.5%), partial HH (114 HH, 13%), and HH with macular sparing (66 HH, 7%). A total of 407 HH (45.0%) were isolated. Causes of HH included stroke (629 HH, 69.6%), trauma (123, 13.6%), tumor (102, 11.3%), brain surgery (22, 2.4%), demyelination (13, 1.4%), other rare causes (13, 1.4%), and unknown etiology (2, 0.2%). The lesions were most commonly located in the occipital lobes (45%) and the optic radiations (32.2%). Every type of HH, except for unilateral loss of temporal crescent and homonymous sectoranopia, was found in all lesion locations along the retrochiasmal visual pathways. Conclusion: Homonymous hemianopia is usually secondary to stroke, head trauma, and tumors. Although the characteristics of visual field defects can be helpful in lesion location, specific visual field defects do not always indicate specific brain locations.展开更多
一名24岁女性,在经历了短暂的意识丧失之后来到急诊,被诊断为惊恐发作并出院。2天后,因头痛加剧和视觉障碍,她被再次送回医院进行进一步的检查。第3天行头颅计算机断层扫描及静脉造影成像采集,结果均正帯。在第7天,她进行了腰椎穿刺,脑...一名24岁女性,在经历了短暂的意识丧失之后来到急诊,被诊断为惊恐发作并出院。2天后,因头痛加剧和视觉障碍,她被再次送回医院进行进一步的检查。第3天行头颅计算机断层扫描及静脉造影成像采集,结果均正帯。在第7天,她进行了腰椎穿刺,脑脊液开放压力为70 cm CSFo第8天,眼底镜检查发现视乳头水肿。最佳矫正视力下降至双眼6/24,同时面对面检查双眼周边视野缺损。她被诊断为暴发性原发颅内高压症,并转到神经科学中心,第9天在那里急诊行了腰椎腹膜分流术。术后2周,双眼视力提高到6/9。展开更多
文摘Objective: To describe the characteristics of spontaneous recovery of homonymous hemianopia (HH). Methods: The authors reviewed medical records of all patients with HH confirmed by formal visual field testing and seen in follow-up in their service between 1989 and 2004. Clinical characteristics, causes, neuroradiologic definition of lesion location, final outcome, and evolution of the visual field defects were recorded. The associations among final visual field defect outcome, time from injury, and clinical features were analyzed. Results: A total of 254 patients with 263 HH were included in this study. Spontaneous visual field defect recovery was observed in 101 HH (38.4%). The likelihood of spontaneous recovery decreased with increasing time from injury to initial visual field testing (p = 0.0003). The probability of improvement was related to the time since injury (p = 0.0003) with a 50 to 60%chance of improvement for cases tested within 1 month after injury that decreased to about 20%for cases tested at 6 months after surgery. No other factor was found to correlate with the final outcome of the visual field defects. Improvement after 6 months from injury was mild and usually related to improvement of the underlying disease. Conclusion: Spontaneous improvement of homonymous hemianopia is seen in at least 50%of patients first seen within 1 month of injury. In most cases, the improvement occurs within the first 3 months from injury. Spontaneous improvement after 6 months postinjury should be interpreted with caution as it is most likely related to improvement of the underlying disease or to improvement in the patient’s ability to perform visual field testing reliably.
文摘Objective: To describe the clinical characteristics and clinical-anatomic correlations of homonymous hemianopia (HH). Background: Homonymous hemianopia impairs visual function and frequently precludes driving. Most knowledge of HH is based on relatively few cases with clinical-anatomic correlations. Methods: The authors reviewed medical records of all patients with HH seen in their service between 1989 and 2004. Demographic characteristics, characteristics of visual field defects, causes of visual field defects, neuroradiologic definition of lesion location, and associated neurologic deficits were recorded. Results: A total of 904 HH were found in 852 patients. A total of 340 HH (37.6%) were complete and 564 HH (62.4%) were incomplete. Homonymous quadrantanopia (264 HH, 29%) was the most common type of incomplete HH, followed by homonymous scotomatous defects (116 HH, 13.5%), partial HH (114 HH, 13%), and HH with macular sparing (66 HH, 7%). A total of 407 HH (45.0%) were isolated. Causes of HH included stroke (629 HH, 69.6%), trauma (123, 13.6%), tumor (102, 11.3%), brain surgery (22, 2.4%), demyelination (13, 1.4%), other rare causes (13, 1.4%), and unknown etiology (2, 0.2%). The lesions were most commonly located in the occipital lobes (45%) and the optic radiations (32.2%). Every type of HH, except for unilateral loss of temporal crescent and homonymous sectoranopia, was found in all lesion locations along the retrochiasmal visual pathways. Conclusion: Homonymous hemianopia is usually secondary to stroke, head trauma, and tumors. Although the characteristics of visual field defects can be helpful in lesion location, specific visual field defects do not always indicate specific brain locations.
文摘一名24岁女性,在经历了短暂的意识丧失之后来到急诊,被诊断为惊恐发作并出院。2天后,因头痛加剧和视觉障碍,她被再次送回医院进行进一步的检查。第3天行头颅计算机断层扫描及静脉造影成像采集,结果均正帯。在第7天,她进行了腰椎穿刺,脑脊液开放压力为70 cm CSFo第8天,眼底镜检查发现视乳头水肿。最佳矫正视力下降至双眼6/24,同时面对面检查双眼周边视野缺损。她被诊断为暴发性原发颅内高压症,并转到神经科学中心,第9天在那里急诊行了腰椎腹膜分流术。术后2周,双眼视力提高到6/9。
