Quadrantanopia

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Quadrantanopia
Other namesQuadrant anopia
Right-superior-quadrantanopia.svg
Right homonymous superior quadrantanopia. The areas of the field lost in each eye are shown as black areas. This visual field defect is characteristic of damage to Meyer's loop on the left side of the brain.
Specialty Ophthalmology   OOjs UI icon edit-ltr-progressive.svg

Quadrantanopia,quadrantanopsia, refers to an anopia (loss of vision) affecting a quarter of the visual field.

Contents

It can be associated with a lesion of an optic radiation. [1] While quadrantanopia can be caused by lesions in the temporal and parietal lobes of the brain, it is most commonly associated with lesions in the occipital lobe. [2]

Presentation

An interesting aspect of quadrantanopia is that there exists a distinct and sharp border between the intact and damaged visual fields, due to an anatomical separation of the quadrants of the visual field. For example, information in the left half of visual field is processed in the right occipital lobe and information in the right half of the visual field is processed in the left occipital lobe. [2]

Example of the sharp division between the blind and intact fields (for someone with hemianopsia, rather than quadrantanopia, in this case) Paris as seen with left homonymous hemianopsia.png
Example of the sharp division between the blind and intact fields (for someone with hemianopsia, rather than quadrantanopia, in this case)

In a quadrantanopia that is partial, there also exists a distinct and sharp border between the intact and damaged field within the quadrant. The sufferer is able to detect light within the damaged visual field.[ citation needed ]

The prospects of recovering vision in the affected field are bleak. Occasionally, patients will spontaneously recover vision in the affected field within the first three months after the brain injury; however, vision loss remaining after this period of spontaneous recovery is traditionally thought to be permanent, certain companies now claim to be able to induce recovery of vision after this three-month period. [3]

Homonymous inferior/superior quadrantanopia

Homonymous denotes a condition which affects the same portion of the visual field of each eye. [4]

Homonymous inferior quadrantanopia is a loss of vision in the same lower quadrant of visual field in both eyes whereas a homonymous superior quadrantanopia is a loss of vision in the same upper quadrant of visual field in both eyes. [5]

A lesion affecting one side of the temporal lobe may cause damage to the inferior optic radiations (known as the temporal pathway or Meyer's loop) which can lead to superior quadrantanopia on the contralateral side of both eyes (colloquially referred to as "pie in the sky"); if the superior optic radiations (parietal pathway) are lesioned, the visual loss occurs on the inferior contralateral side of both eyes and is referred to as an inferior quadrantanopia. [6]

Binasal/bitemporal quadrantanopia

Binasal (either inferior or superior) quadrantanopia, also known as Nerurkarian field defects affects either the upper or lower inner visual quadrants closer to the nasal cavity in both eyes. Bitemporal (either inferior or superior) quadrantanopia affects either the upper or lower outer visual quadrants in both eyes.[ citation needed ]

Compensatory behaviors

Individuals with quadrantanopia often modify their behavior to compensate for the disorder, such as tilting of the head to bring the affected visual field into view. [7] Drivers with quadrantanopia, who were rated as safe to drive, drive slower, utilize more shoulder movements and, generally, corner and accelerate less drastically than typical individuals or individuals with quadrantanopia who were rated as unsafe to drive. The amount of compensatory movements and the frequency with which they are employed is believed to be dependent on the cognitive demands of the task; when the task is so difficult that the subject's spatial memory is no longer sufficient to keep track of everything, patients are more likely to employ compensatory behavior of biasing their gaze to the afflicted side. [8] Teaching individuals with quadrantanopia compensatory behaviors could potentially be used to help train patients to re-learn to drive safely.[ citation needed ]

Related Research Articles

<span class="mw-page-title-main">Optic nerve</span> Second cranial nerve, which connects the eyes to the brain

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.

<span class="mw-page-title-main">Parietal lobe</span> Part of the brain responsible for sensory input and some language processing

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.

<span class="mw-page-title-main">Occipital lobe</span> Part of the brain at the back of the head

The occipital lobe is one of the four major lobes of the cerebral cortex in the brain of mammals. The name derives from its position at the back of the head, from the Latin ob, 'behind', and caput, 'head'.

<span class="mw-page-title-main">Internal capsule</span> White matter structure situated in the inferomedial part of each cerebral hemisphere of the brain

The internal capsule is a paired white matter structure, as a two-way tract, carrying ascending and descending fibers, to and from the cerebral cortex. The internal capsule is situated in the inferomedial part of each cerebral hemisphere of the brain. It carries information past the subcortical basal ganglia. As it courses it separates the caudate nucleus and the thalamus from the putamen and the globus pallidus. It also separates the caudate nucleus and the putamen in the dorsal striatum, a brain region involved in motor and reward pathways.

<span class="mw-page-title-main">Optic radiation</span> Neural pathway in the visual system

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.

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 mostly on the structure inside the visual field and it is then considered “the field of functional capacity obtained and recorded by means of perimetry”.

<span class="mw-page-title-main">Optic tract</span> Neural pathway within the human visual system

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.

<span class="mw-page-title-main">Binasal hemianopsia</span> Loss of vision in the inner half of both the right and left visual field

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.

<span class="mw-page-title-main">Middle cerebral artery</span> Paired artery that supplies blood to the cerebrum

The middle cerebral artery (MCA) is one of the three major paired cerebral arteries that supply blood to the cerebrum. The MCA arises from the internal carotid artery and continues into the lateral sulcus where it then branches and projects to many parts of the lateral cerebral cortex. It also supplies blood to the anterior temporal lobes and the insular cortices.

<span class="mw-page-title-main">Posterior cerebral artery</span> Artery which supplies blood to the occipital lobe of the brain

The posterior cerebral artery (PCA) is one of a pair of cerebral arteries that supply oxygenated blood to the occipital lobe, part of the back of the human brain. The two arteries originate from the distal end of the basilar artery, where it bifurcates into the left and right posterior cerebral arteries. These anastomose with the middle cerebral arteries and internal carotid arteries via the posterior communicating arteries.

<span class="mw-page-title-main">Hemianopsia</span> Loss of vision in half the visual field

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.

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.

<span class="mw-page-title-main">Homonymous hemianopsia</span> Visual field loss on the left or right side of the vertical midline

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.

<span class="mw-page-title-main">Chiasmal syndrome</span> Set of signs and symptoms that are associated with lesions of the optic chiasm

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.

<span class="mw-page-title-main">Posterior cerebral artery syndrome</span> Medical condition

Posterior cerebral artery syndrome is a condition whereby the blood supply from the posterior cerebral artery (PCA) is restricted, leading to a reduction of the function of the portions of the brain supplied by that vessel: the occipital lobe, the inferomedial temporal lobe, a large portion of the thalamus, and the upper brainstem and midbrain.

<span class="mw-page-title-main">Middle cerebral artery syndrome</span> Medical condition

Middle cerebral artery syndrome is a condition whereby the blood supply from the middle cerebral artery (MCA) is restricted, leading to a reduction of the function of the portions of the brain supplied by that vessel: the lateral aspects of frontal, temporal and parietal lobes, the corona radiata, globus pallidus, caudate and putamen. The MCA is the most common site for the occurrence of ischemic stroke.

The neuroanatomy of memory encompasses a wide variety of anatomical structures in the brain.

<span class="mw-page-title-main">Occipital epilepsy</span> Medical condition

Occipital epilepsy is a neurological disorder that arises from excessive neural activity in the occipital lobe of the brain that may or may not be symptomatic. Occipital lobe epilepsy is fairly rare, and may sometimes be misdiagnosed as migraine when symptomatic. Epileptic seizures are the result of synchronized neural activity that is excessive, and may stem from a failure of inhibitory neurons to regulate properly.

<span class="mw-page-title-main">Visual pathway lesions</span> Visual maladies

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

References

  1. Yale- Cranial Nerve 2, pg. 11 Archived June 7, 2008, at the Wayback Machine
  2. 1 2 Kolb, B & Whishaw, I.Q. Human Neuropsychology, Sixth Edition, p.361; Worth Publishers (2008) ISBN   978-0-7167-9586-5
  3. Rehabilitation for Homonymous Hemianopia and Quadrantanopia Archived July 1, 2013, at the Wayback Machine
  4. Bickley, Lynn S. (2017). Bates' Guide to Physical Examination and History Taking. Wolters Kluwer. p. 273. ISBN   9781469893419.
  5. William J. Weiner: Neurology for the Non-Neurologist, p.526; Lippincott Williams & Wilkins (July 2010) ISBN   1605472395
  6. Central Visual Pathways Archived March 10, 2008, at the Wayback Machine
  7. Visual Fields in Brain Injury - Hemianopsia.net Everything you need to know about Hemianopsia
  8. Wood JM, McGwin G, Elgin J, Vaphiades MS, Braswell RA, DeCarlo DK, Kline LB, Owsley C (2011). "Hemianopic and quadrantanopic field loss, eye and head movements, and driving". Invest. Ophthalmol. Vis. Sci. 52 (3): 1220–5. doi:10.1167/iovs.10-6296. PMC   3101691 . PMID   21367969.