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Hemianopsia | |
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Paris as seen with full visual fields | |
Specialty | Ophthalmology, neurology |
Hemianopsia, or hemianopia, is a loss of vision or blindness (anopsia) in half the visual field, usually on one side of the vertical midline. The most common causes of this damage are stroke, brain tumor, and trauma. [1]
This article deals only with permanent hemianopsia, and not with transitory or temporary hemianopsia, as identified by William Wollaston PRS in 1824. [2] Temporary hemianopsia can occur in the aura phase of migraine.
The word hemianopsia is from Greek origins, where:
When the pathology involves both eyes, it is either homonymous or heteronymous.
A homonymous hemianopsia is the loss of half of the visual field on the same side in both eyes. The visual images that we see to the right side travel from both eyes to the left side of the brain, while the visual images we see to the left side in each eye travel to the right side of the brain. Therefore, damage to the right side of the posterior portion of the brain or right optic tract can cause a loss of the left field of view in both eyes. Likewise, damage to the left posterior brain or left optic radiation can cause a loss of the right field of vision. [3]
A heteronymous hemianopsia is the loss of half of the visual field on different sides in both eyes. It is separated into two categories:
Quadrantanopia (quadrantanopsia or quadrantic hemianopsia) is decreased vision or blindness in one quarter of the visual field. The particular quarter of vision missing depends on whether the location of the brain damage is temporal or parietal, and the side of the lesion. [4] For example, a lesion to the right temporal lobe with damage specifically to Meyer's loop will give rise to a left upper (superior) quadrantanopsia, while a lesion to the right parietal radiation with damage specifically to Baum's loop will result in a left lower (inferior) quadrantanopsia. [5]
Visual neglect (also called hemispatial neglect or unilateral spatial neglect) differs from hemianopsia in that it is an attentional deficit rather than a visual one. Unlike patients with hemianopsia who actually don't see, those with visual neglect have no trouble seeing but are impaired in attending to and processing the visual information they receive. Whereas hemianopsia can be assuaged by allowing patients to move their eyes around a visual scene (ensuring that the entire scene makes it into their intact visual field), neglect cannot. Neglect can also apply to auditory or tactile stimuli and can even leave a patient unaware of one side of his or her own body. [6]
Ellis and Young (1998) showed that neglect can also affect patients' mental maps such that if they are asked to picture themselves standing in a familiar location and name the buildings around them, they will neglect to name the buildings on their impaired side but will be able to name them when asked to mentally face the opposite direction. [7]
Some patients with neglect also have hemianopsia, however the two often occur independent of one another.
Some forms of hemianopia can be treated through repeated presentations of multisensory stimuli due to the process of multisensory integration occurring in the superior colliculus. [8]
Surgical interventions have also been shown to ameliorate certain forms of hemianopia due to counterbalancing brain lesions due to a process known as the Sprague effect. [9]
In neuroanatomy, the optic nerve, also known as the second cranial nerve, cranial nerve II, or simply CN II, is a paired cranial nerve that transmits visual information from the retina to the brain. In humans, the optic nerve is derived from optic stalks during the seventh week of development and is composed of retinal ganglion cell axons and glial cells; it extends from the optic disc to the optic chiasma and continues as the optic tract to the lateral geniculate nucleus, pretectal nuclei, and superior colliculus.
Blindsight is the ability of people who are cortically blind to respond to visual stimuli that they do not consciously see due to lesions in the primary visual cortex, also known as the striate cortex or Brodmann Area 17. The term was coined by Lawrence Weiskrantz and his colleagues in a paper published in a 1974 issue of Brain. A previous paper studying the discriminatory capacity of a cortically blind patient was published in Nature in 1973. The assumed existence of blindsight is controversial, with some arguing that it is merely degraded conscious vision.
The parietal lobe is one of the four major lobes of the cerebral cortex in the brain of mammals. The parietal lobe is positioned above the temporal lobe and behind the frontal lobe and central sulcus.
In neuroanatomy, the optic radiation are axons from the neurons in the lateral geniculate nucleus to the primary visual cortex. The optic radiation receives blood through deep branches of the middle cerebral artery and posterior cerebral artery.
A scotoma is an area of partial alteration in the field of vision consisting of a partially diminished or entirely degenerated visual acuity that is surrounded by a field of normal – or relatively well-preserved – vision.
The visual field is "that portion of space in which objects are visible at the same moment during steady fixation of the gaze in one direction"; in ophthalmology and neurology the emphasis is on the structure inside the visual field and it is then considered “the field of functional capacity obtained and recorded by means of perimetry”.
Hemispatial neglect is a neuropsychological condition in which, after damage to one hemisphere of the brain, a deficit in attention and awareness towards the side of space opposite brain damage is observed. It is defined by the inability of a person to process and perceive stimuli towards the contralesional side of the body or environment. Hemispatial neglect is very commonly contralateral to the damaged hemisphere, but instances of ipsilesional neglect have been reported.
In neuroanatomy, the optic tract is a part of the visual system in the brain. It is a continuation of the optic nerve that relays information from the optic chiasm to the ipsilateral lateral geniculate nucleus (LGN), pretectal nuclei, and superior colliculus.
An eye examination is a series of tests performed to assess vision and ability to focus on and discern objects. It also includes other tests and examinations pertaining to the eyes. Eye examinations are primarily performed by an optometrist, ophthalmologist, or an orthoptist. Health care professionals often recommend that all people should have periodic and thorough eye examinations as part of routine primary care, especially since many eye diseases are asymptomatic.
Bitemporal hemianopsia, is the medical description of a type of partial blindness where vision is missing in the outer half of both the right and left visual field. It is usually associated with lesions of the optic chiasm, the area where the optic nerves from the right and left eyes cross near the pituitary gland.
Binasal hemianopsia is the medical description of a type of partial blindness where vision is missing in the inner half of both the right and left visual field. It is associated with certain lesions of the eye and of the central nervous system, such as congenital hydrocephalus.
Macular sparing is visual field loss that preserves vision in the center of the visual field, otherwise known as the macula. It appears in people with damage to one hemisphere of their visual cortex, and occurs simultaneously with bilateral homonymous hemianopia or homonymous quadrantanopia. The exact mechanism behind this phenomenon is still uncertain. The opposing effect, where vision in half of the center of the visual field is lost, is known as macular splitting.
Hemianopsia, or hemianopia, is a visual field loss on the left or right side of the vertical midline. It can affect one eye but usually affects both eyes.
Focal neurologic signs also known as focal neurological deficits or focal CNS signs are impairments of nerve, spinal cord, or brain function that affects a specific region of the body, e.g. weakness in the left arm, the right leg, paresis, or plegia.
Chiasmal syndrome is the set of signs and symptoms that are associated with lesions of the optic chiasm, manifesting as various impairments of the affected's visual field according to the location of the lesion along the optic nerve. Pituitary adenomas are the most common cause; however, chiasmal syndrome may be caused by cancer, or associated with other medical conditions such as multiple sclerosis and neurofibromatosis.
Quadrantanopia,quadrantanopsia, refers to an anopia affecting a quarter of the visual field.
Extinction is a neurological disorder that impairs the ability to perceive multiple stimuli of the same type simultaneously. Extinction is usually caused by damage resulting in lesions on one side of the brain. Those who are affected by extinction have a lack of awareness in the contralesional side of space and a loss of exploratory search and other actions normally directed toward that side.
Amorphosynthesis, also called a hemi-sensory deficit, is a neuropsychological condition in which a patient experiences unilateral inattention to sensory input. This phenomenon is frequently associated with damage to the right cerebral hemisphere resulting in severe sensory deficits that are observed on the contralesional (left) side of the body. A right-sided deficit is less commonly observed and the effects are reported to be temporary and minor. Evidence suggests that the right cerebral hemisphere has a dominant role in attention and awareness to somatic sensations through ipsilateral and contralateral stimulation. In contrast, the left cerebral hemisphere is activated only by contralateral stimuli. Thus, the left and right cerebral hemispheres exhibit redundant processing to the right-side of the body and a lesion to the left cerebral hemisphere can be compensated by the ipsiversive processes of the right cerebral hemisphere. For this reason, right-sided amorphosynthesis is less often observed and is generally associated with bilateral lesions.
The Sprague effect is the phenomenon where homonymous hemianopia, caused by damage to the visual cortex, gets slightly better when the contralesional superior colliculus is destroyed. The effect is named for its discoverer, James Sprague, who observed this phenomenon in 1966 using a cat model. Several reasons have been thought of for this happening, including mutual inhibition between the two brain hemispheres. For similar reasons of inhibiting an inhibitory structure, damaging the substantia nigra, for instance by using ibotenic acid, can also cause the same improvement.
The visual pathway consists of structures that carry visual information from the retina to the brain. Lesions in that pathway cause a variety of visual field defects. In the visual system of human eye, the visual information processed by retinal photoreceptor cells travel in the following way:
Retina→Optic nerve→Optic chiasma →Optic tract→Lateral geniculate body→Optic radiation→Primary visual cortex