Binasal hemianopia caused by pneumosinus dilatans of the sphenoid sinuses

Bitemporal hemianopia is a significant pathological hallmark of a pituitary lesion; however, binasal hemianopia is rarely reported, except for its known association with other ocular diseases rather than with brain lesions. We report a 24-year-old male with binasal hemianopia caused by pneumosinus dilatans of the sphenoid sinuses.

Digital Therapeutics: Emerging New Therapy for Neurologic Deficits after Stroke / 대한뇌졸중학회지

Digital therapeutics is an evidence-based intervention using high-quality software, with the sole purpose of treatment. As many healthcare systems are encountering high demands of quality outcomes, the need for digital therapeutics is gradually increasing in the clinical field. We conducted review of the implications of digital therapeutics in the treatment of neurological deficits for stroke patients. The implications of digital therapeutics have been discussed in four domains: cognition, speech and aphasia, motor, and vision. It was evident that different forms of digital therapeutics such as online platforms, virtual reality trainings, and iPad applications have been investigated in many trials to test its feasibility in clinical use. Although digital therapeutics may deliver high-quality solutions to healthcare services, the medicalization of digital therapeutics is accompanied with many limitations. Clinically validated digital therapeutics should be developed to prove its efficacy in stroke rehabilitation.

Anti-myelin oligodendrocyte glycoprotein antibody associated neuromyelitis optica spectrum disorder presenting homonymous hemianopia

@#Anti-aquaporin 4 antibody is the most common cause of neuromyelitis optica spectrum disorder (NMOSD) and anti-myelin oliogodendrocyte glycoprotein (MOG) antibody recently has emerged as another cause of NMOSD. Visual field defect can be observed as a manifestation of optic neuritis in patients with multiple sclerosis and NMOSD. However, homonymous hemianopia associated with a visual cortex lesion has been rarely reported in patients with multiple sclerosis and anti-aquaporin 4-positive NMOSD. Recently, we experienced a case of MOG-positive NMOSD who presented with a homonymous hemianopia associated with a visual cortex lesion

Microsurgical management of meningiomas in the trigone of the lateral ventricle / 医学研究生学报

Objective Meningiomas in the trigone of the lateral ventricle are characterized by deep location and low inci-dence. A few studies have been done on its treatment at home and abroad. This study was to explore the access,techniques,and clini-cal effect of microsurgery for lateral ventricular trigone meningiomas (LVTM). Methods We retrospectively analyzed the clinical data about 36 cases of LVTM treated by microsurgery in our hospital from December 2011 to December 2015. The operation involved lumbar cistern tube drainage, intraoperative drainage of cerebrospinal fluid, a unilateral parieto-occipital U-shaped cut, approach through the interparietal fissure,a sagittal incision about 3 cm long at the interparietal fissure for exposure and resection of the tumor. We followed up the patients for a mean of 17 months postoperatively and analyzed the results and complications. Results Simpson grade I removal of the tumors was achieved in all the 36 cases. Postoperative complications included homonymous hemianopia in 4 cases, central nervous system infections in 3,secondary epilepsy in 2,subcutaneous hydrops in 2,and intratumoral hemorrhage in 1 (which necessitated a second operation). Extended temporal horn of the right lateral ventricle occurred at 32 months after surgery,which was treated by fistulation. Homonymous hemianopia was improved in 2 of the 4 ca-ses. All the patients were capable of daily life activities and none experienced recurrence. Conclusion Sufficient preoperative evalu-ation of the tumor characteristics,rational selection of surgical approach,and expert operation techniques are the key factors for the mi-crosurgical treatment of meningiomas in the trigone of the lateral ventricle.

Occipital Lobe Metastasis of Hepatocellular Carcinoma Presenting as Homonymous Hemianopia

PURPOSE: To report brain metastasis of hepatocellular carcinoma presenting as homonymous hemianopia. CASE SUMMARY: A 51-year-old female with a history of hepatectomy and diagnosis of hepatocellular carcinoma (HCC) 19 months earlier was referred to our neuro-ophthalmology clinic for evaluation due to headache and decreased visual acuity over the past several months. Best visual acuity was 20/20, and the results of all other aspects of our examination were normal except Humphrey automatic perimetry, which showed complete left homonymous hemianopia. Brain magnetic resonance imaging showed a large mass in the right occipital lobe. Craniotomy and removal of tumor were performed. HCC was confirmed by histopathologic examination. CONCLUSIONS: Metastasis of hepatocellular carcinoma to the occipital lobe is extremely rare but can present as homonymous hemianopia. Therefore, clinicians should be aware of this when examining a patient with a history of HCC.

Isolated complete bitemporal hemianopia in traumatic chiasmal syndrome.

A 29-year-old man presented with a chief complaint of lateral blindness in the left eye at 4 months after an accidental fall. His best corrected visual acuity was 0.7 in the left eye and 1.0 in the right eye. Visual field test showed a complete bitemporal hemianopic defect without any neurologic symptoms. An orbital computed tomography scan with non-enhancement conducted at the time of the visit showed multiple frontal skull fractures and cerebromalacia a small fracture in the sphenoidal boneboth frontal lobes. No radiological abnormalities of the visual pathway were detected. Optical coherence showed reduced thickness in the retinal nerve fiber layer, primarily in the superior and inferior part of the left eye. To our knowledge, a complete bitemporal hemianopia without neurological deficits is extremely rare in traumatic chiasmal syndrome.

Hemianopsia homônima como síndrome clínica isolada com alto potencial deconversão para esclerose múltipla / Homonymous hemianopia as an isolated clinical syndrome with high potential for conversion to multiple sclerosis

Introdução: A hemianopsia homônima ocorre apenas na presença de lesão retroquiasmática, sendo uma rara apresentação de doença desmielinizante. Objetivo: Relatar um caso raro de hemianopsia homônima como manifestação inicial de síndrome clinicamente isolada. Método: Foi realizada uma revisão de 809 prontuários médicos de pacientes com esclerose múltipla (EM) tratados no Hospital da Lagoa (Rio de Janeiro) entre 1995 e 2011, para identificação de casos de hemianopsiahomônima como manifestação inicial da doença. Relato de caso: Paciente do sexo feminino, 48 anos, apresentou em agosto de 2011 quadro de hemianopsia homônima esquerda incongruente associada à lesão em topografia do trato óptico direito, evidenciada na RM de crânio, que também revelou lesões periventriculares e em substância branca subcortical, compatíveis com doença desmielinizante. O exame do líquido cefalorraquidiano (LCR) revelou hiperproteinemia leve com síntese intratecal de IgG e IgM, e o estudo do potencial visual evocado mostrou comprometimento parcial das vias ópticas bilateralmente. Concluído o diagnóstico de síndrome clinicamente isolada, a paciente foi submetida à pulsoterapia com metilprednisolona, com remissão das queixas visuais e melhora acentuada do campo visual no segundo exame realizado. O diagnóstico de EM foi concluído em dezembro de 2011, com o resultado da segunda RM, que revelou redução no tamanho da lesão em topografia do trato óptico direito e persistência das lesões focais periventriculares e subcorticais, com o surgimento de novas lesões frontais captantes de contraste. Conclusão: Embora a neurite óptica seja a manifestação ocular mais frequente da síndrome clinicamente isolada, deve-se estar atento a outras formas atípicas de apresentação para que se possa fazer um diagnóstico precoce. Os defeitos de campo visual na EM geralmente têm bom prognóstico com o tratamento adequado...

Introduction: Homonymous hemianopia occurs only in the presenceof retrochiasmatic injury, being a rare presentation of demyelinatingdisease. Objective: To report a rare case of homonymoushemianopia as the initial manifestation of clinically isolated syndrome.Method: We conducted a review of medical records of 809 patientswith multiple sclerosis (MS) treated at Hospital da Lagoa (Rio de Janeiro) between 1995 and 2011, being found only one case of homonymous hemianopia as the initial manifestation of the disease. Case report: Female patient, 48 years old, presented in August 2011 incongruous left homonymous hemianopia associated with lesion in topography of the right optic tract evidenced in MRI, which also revealed lesions in periventricular and subcortical white matter, consistent with demyelinating disease. CSF revealed mild hyperproteinemia with intrathecal synthesis of IgG and IgM, and visual evoked potential study showed partial compromise of the optic pathways bilaterally. Completed the diagnostic of clinically isolated syndrome, the patient underwent pulse therapy with methylprednisolone, with remission of visual complaints and marked improvement of the visual in the second examination performed. The diagnosis of MS was completed in December 2011 with the result of the second MRI, which revealed a reduction in the lesion size in the right optic tract topography and persistence of periventricular and subcortical focal lesions, with theemergence of new frontal lesions uptake of contrast. Conclusion:Although optic neuritis is the most common ocular manifestation ofclinically isolated syndrome, we should be mindful of other atypicalforms of presentation so that we can make an early diagnosis. Thevisual defects in MS usually have a good prognosis with appropriatetreatment...

Progressive multifocal leukoence-phalopathy presenting as homonymous hemianopia in a patient with acquired immunodeficiency syndrome.

We present a case of a Human Immunodeficiency Virus (HIV) positive patient who was referred for retinal evaluation to rule out ophthalmic manifestations of Acquired Immunodeficiency Syndrome (AIDS). She complained of some disturbance in vision in both eyes. Fundus examination showed no abnormality. Perimetry, done to rule out optic nerve pathology, showed a left homonymous hemianopia. Magnetic Resonance Imaging (MRI) scan showed features of Progressive Multifocal Leukoencephalopathy (PML). She had no other neurological symptoms or signs.

Ophthalmic contributions of Raja Serfoji II (1798–1832).

Purpose: To investigate and describe the ophthalmic contribution of Raja Serfoji II (1798-1832). Materials and Method: A team of 2 ophthalmologists, director of laboratory services, one archeologist and a photographer visited Sarasvathi Mahal Library, March 2004. Photographs of ophthalmic records were taken and analysed. An interview of the present prince, S Babaji Rajah Bhonsle was taken. Ophthalmologic case sheets of 44 patients, 18 pictures were found. Results: Forty-four patient's ophthalmic records were found. Six records were written in Modi script, 38 were written in English and 18 drawings were found. Conclusion: In Thanjavur, King Serfoji II carried out methodical ophthalmic practices between 1798 and 1832. Both European and Indian medicines were used. Cataract Surgery was performed. Detailed ophthalmic records were maintained. The only evidence of Serfoji's amazing contribution to medicine lies in 50 charts and manuscripts.

Visual fields in neuro-ophthalmology.

Visual field assessment is important in the evaluation of lesions involving the visual pathways and should be performed at baseline and periodically in the follow-up. Standard automated perimetry has been shown to be adequate in neuro-ophthalmic practise and is now the technique of choice for a majority of practitioners. Goldman kinetic visual fields are useful for patients with severe visual and neurologic deficits and patients with peripheral visual field defects. Visual fields are useful in monitoring progression or recurrence of disease and guide treatment for conditions such as idiopathic intracranial hypertension (IIH), optic neuropathy from multiple sclerosis, pituitary adenomas, and other sellar lesions. They are used as screening tools for toxic optic neuropathy from medications such as ethambutol and vigabatrin. Visual field defects can adversely affect activities of daily living such as personal hygiene, reading, and driving and should be taken into consideration when planning rehabilitation strategies. Visual field testing must be performed in all patients with lesions of the visual pathway.

Protein C and protein S: Causative factor for developing a hemorrhagic infarct in a HbE/Beta thalassemia child.

A 10-yr-old HbE/Beta thalassemia child who developed subacute to chronic occipitotemporal hemorrhagic infarct with smaller chronic infarct with gliotic changes in the left frontal periventricular white matter. Genetic tests showed that patient was positive for HbE and IVS1-5 mutation and was negative for thrombogenic mutations. Hemorrhagic infarct was confirmed by magnetic resonance imaging study. Antigenic levels of Protein C and Protein S were low. Based on these outcomes, it was concluded that Protein C and Protein S deficiency were the causative factor for developing hemorrhagic infarct in the HbE/ Beta thalassemia patient.

A Case of Functional Bitemporal Hemianopia Respecting the Vertical Meridian

PURPOSE: To report a case of functional bilateral hemianopia which was not associated with any organic causes. CASE SUMMARY: A 35-year-old female patient presented with bilateral disturbance of visual acuity and visual field, which had begun 8 months prior. Goldmann perimetry showed bitemporal hemianopsia respecting the vertical meridian. Pupillary response was normal, and the anterior segment, fundus, and optic nerve were also normal bilaterally. However, the tangent screen test and Humphrey visual field test showed a widening of hemianopia not respecting the vertical meridian, and the crossing of isopters at 1 m and 2 m with the tangent screen test. In addition, multifocal electroretinogram and multifocal visual evoked potential did not reveal any abnormal findings corresponding to the bitemporal hemianopia. Brain magnetic resonance imaging showed no abnormal findings in the orbit and brain. CONCLUSIONS: Bitemporal hemianopsia can be developed functionally, although it may be rare. Repetition of various visual field tests and use of multifocal electrophysiologic studies can be helpful in the differential diagnosis.

Rehabilitation of Hemiplegic Patient with Bilateral Hemianopia:One Case Report / 中国康复理论与实践

@#Cerebrovascular diseases can lead to hemiplegia,hemiparaesthesia and hemianopia.However,patients with poor eyesight resulting from bilateral cerebral infarction are rare.The authors reported here the rehabilitation assessment and treatment of one case with hemiplegia and poor eyesight resulting from bilateral cerebral infarction.According to the poor eyesight of the patient,a rehabilitation program which was different from common program was designed,and the patient can walk independently and achieve basic activities of daily living independence underlying the treatment of the new rehabilitation program.The attention should be paid on the variant rehabilitation treatment process depending on variant condition of patients.

Correlation of OCT and Hemifield Pattern VEP in Hemianopia

PURPOSE: To analyze the correlation between RNFL thickness changes measured by OCT and hemifield pattern VEP in hemianopic visual field loss. METHODS: Twelve eyes of six patients with hemianopia were studied. Two patients had bitemporal hemianopia caused by chiasmal tumor, one patient had inferior hemianopia caused by traumatic optic neuropathy, and three patients had homonymous hemianopia caused by occipital lobe lesions. The retinal nerve fiber layer thickness around the optic disc was measured by optical coherence tomography (OCT) and visual pattern evoked potentials were measured using hemifield stimulations. RESULTS: Normal eyes of traumatic optic neuropathy patients were excluded from the analysis. The retinal nerve fiber layer thickness as measured by OCT corresponded to the visual field defect in 9 of 11 eyes (81.8%) and the hemifield pattern VEP response corresponded to visual field defect in 7 of 11 eyes (63.6%). CONCLUSIONS: RNFL thickness measurement by OCT and hemifield PVEP are useful in evaluation of patients with hemianopia. However, they should be performed with caution, and compared with various clinical examinations because of their incomplete correlation with visual field defects.

Relationship between hemispatial neglect and homonymous hemianopia / 中国医师进修杂志

0.05). Conclusion HSN is a right cerebral hemisphere disease relating to cognitive impairment while homonymous hemianopia is the defect of visual field.

A Case of Optic Neuritis Involving Optic Chiasm

PURPOSE: To report a case of optic neuritis with incongruous homonymous hemianopia involving optic chiasm. METHODS: A twenty five year old female patient complaining of decreased visual acuity in left eye for 4 days was referred from department of neurology. Best corrected visual acuity was 1.0 in the right eye and counting fingers at 20 cm in the left eye. Left afferent pupillary defect was detected. The conventional magnetic resonance image was normal, however on FLAIR image high signal intensity lesion involving left anterior portion of optic nerve, optic chiasm and both optic tract was noted. However the lesion was not easily detected on T2-weighted image. On enhanced MRI image, the lesion was partially enhanced. Visual field showed incongruous homonymous right hemianopia. VEP showed no evoked potentials in left eye stimulation by checkboard pattern and normal response in right eye stimulation. The patient had normal CSF studies and had been treated with high dose intravenous steroid. After 19 days, visual acuity and magnetic resonance image was markedly improved. RESULTS: We experienced a case of optic neuritis with incongruous homonymous hemianopia involving optic chiasm and report this case with literature review as we believe that our case is the first case in our country.

The clinical and SPECT studies of photic stimulation therapy in patients with homonymous hemianopia / 中国康复理论与实践

@#Comparison of rCBF SPECT imaging and clinical visual function of 12 cases with complete homonymous hemianopia (CHH) were taken before and after a course of oriented dynamic color photic stimulation (ODCPS ). It was suggested that ODCPS in patients with CHH was an effective met hod for increasing visual field and improving visual function. Cerebral metabolic patterns of increasing rCBF reflected the mechanism of ODCPS effecting the patients with CHH. The rgtinal- midbrain-occipital visual path way may play an important role in mediating the increase of visual field and restoration of visual function.

Two cases of anterior choroidal artery territory infarction

Occlusion of the anterior choroidal artery (AChA) can cause infarction in the posterior limb of the internal capsule. Infarction is less frequently observed in the thalamus, midbrain, temporal lobe, and lateral geniculate body (LGB) territories of the AChA. The most common clinical finding is hemiparesis. Hemianesthesia may be severe at onset but is usually transient. Homonymous hemianopia, upper-quadrant anopia, or upper- and lower-quadrant sector anopia can be present. Occasionally these patients are reported to have transient abnormalities of higher cortical function. The most common stroke mechanism is known to be small-vessel occlusive disease, predominantly found in hypertensive and diabetic patients. Vasospasm due to ruptured aneurysm or intraoperative mechanical manipulation, and cardiac origin the AChA territory. The infarct lesion is usually recognized and diagnosed by computed tomography. The best treatment is still unknown.