Homonymous hemianopsia

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Homonymous hemianopsia
Paris as seen with left homonymous hemianopsia.png
Paris as seen with left homonymous hemianopsia
Specialty Ophthalmology   OOjs UI icon edit-ltr-progressive.svg
Symptoms clumsiness, decreased night visions, difficulty of straight line walking, distorted sight, doubled vision, frequent turning of the head away from the side where it’s present, lack of awareness where it’s presented, visual Hallucinations
Causesbrain bleed, brain inflammation, brain tumor, dementia, epilepsy, lymphoma, other kinds of brain injuries, and stroke
Diagnostic method magnetic resonance imaging

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.

Contents

Homonymous hemianopsia (or homonymous hemianopia) is hemianopic visual field loss on the same side of both eyes. Homonymous hemianopsia occurs because the right half of the brain has visual pathways for the left hemifield of both eyes, and the left half of the brain has visual pathways for the right hemifield of both eyes. When one of these pathways is damaged, the corresponding visual field is lost.

Signs and symptoms

Paris as seen with right homonymous hemianopsia Rhvf.png
Paris as seen with right homonymous hemianopsia

Mobility can be difficult for people with homonymous hemianopsia. "Patients frequently complain of bumping into obstacles on the side of the field loss, thereby bruising their arms and legs." [1]

People with homonymous hemianopsia often experience discomfort in crowds. "A patient with this condition may be unaware of what he or she cannot see and frequently bumps into walls, trips over objects or walks into people on the side where the visual field is missing." [2]

A related phenomenon is hemispatial neglect, the possible neglect of the right or left. The patient is not conscious of its existence. The right side of the face is not shaven, make up is applied to one side of the face only and only half of a plate of food is eaten. [3] This, however, is not necessarily due to a sensory abnormality, and is therefore distinct from hemianopsia. [4]

Causes

Homonymous hemianopsia can be congenital, but is usually caused by brain injury such as from stroke, trauma, [5] tumors, infection, or following surgery.

Vascular and neoplastic (malignant or benign tumours) lesions from the optic tract, to visual cortex can cause a contralateral homonymous hemianopsia. Injury to the right side of the brain will affect the left visual fields of each eye. The more posterior the cerebral lesion, the more symmetric (congruous) the homonymous hemianopsia will be. For example, a person who has a lesion of the right optic tract will no longer see objects on his left side. Similarly, a person who has a stroke to the right occipital lobe will have the same visual field defect, usually more congruent between the two eyes, and there may be macular sparing. A stroke on the right side of the brain (especially parietal lobe), in addition to producing a homonymous hemianopsia, may also lead to the syndrome of hemispatial neglect.

Transient homonymous hemianopsia does not necessarily mean stroke. For instance, it can constitute the aura phase of migraine. Concomitant presence of a moving scintillating scotoma is suggestive of migraine, [6] but has been seen in cerebral cancer as well. [7] Computed tomography (CT scan) or MRI can be used to investigate if stroke, tumor, structural lesion, or demyelination is the cause of homonymous hemianopsia. [6]

Diagnosis

Homonymous hemianopsia secondary to posterior cerebral artery occlusion – may result in syndromes of memory impairment, opposite visual field loss (homonymous hemianopsia), and sometimes hemisensory deficits. The PCA supplies the occipital lobe and the medial portion of the temporal lobe.

Infarction of occipital cortex typically causes macular sparing hemianopias due to dual blood supply from both posterior cerebral artery and middle cerebral artery.

Occlusion of the calcarine artery that results in infarction of the superior part of the occipital lobe causes a lower peripheral visual field defect.

Posterior cerebral artery penetrating branch occlusion may result in infarction of the posterior capsule, causing hemisensory loss, and (if low enough) a transient hemianopia may also occur.

Management

Prisms or "field expanders" that bend light have been prescribed for decades in patients with hemianopsia. Higher power Fresnel ("stick-on") prisms are commonly employed because they are thin and lightweight, and can be cut and placed in different positions on a spectacle lens.

Peripheral prism spectacles expand the visual field of patients with hemifield visual defects and have the potential to improve visual function and mobility. [8] Prism spectacles incorporate higher power prisms, with variable shapes and designs. The Gottlieb button prism, and the Peli superior and inferior horizontal bands are some proprietary examples of prism glasses. These high power prisms "create" artificial peripheral vision into the non-blind field for obstacle avoidance and motion detection.

Certain counterbalancing brain lesions have also been shown to improve visual deficits in a phenomenon known as the Sprague effect.

Etymology

Homonymous hemianopsia can be broken down as follows:

Homonymous hemianopsia is also called homonymous hemianopia.

See also

Related Research Articles

<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">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 the "spatial array of visual sensations available to observation in introspectionist psychological experiments". Or simply, visual field can be defined as the entire area that can be seen when an eye is fixed straight at a point.

<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">Bitemporal hemianopsia</span> Loss of vision in the outer half of both the right and left visual field

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.

<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">Visual extinction</span>

Visual extinction is a neurological disorder which occurs following damage to the parietal lobe of the brain. It is similar to, but distinct from, hemispatial neglect. Visual extinction has the characteristic symptom of difficulty to perceive contralesional stimuli when presented simultaneously with an ipsilesional stimulus, but the ability to correctly identify them when not presented simultaneously. Under simultaneous presentation, the contralesional stimulus is apparently ignored by the patient, or extinguished. This deficiency may lead to difficulty on behalf of the patient with processing the stimuli's 3D position.

<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">Cerebral achromatopsia</span> Medical condition

Cerebral achromatopsia is a type of color-blindness caused by damage to the cerebral cortex of the brain, rather than abnormalities in the cells of the eye's retina. It is often confused with congenital achromatopsia but underlying physiological deficits of the disorders are completely distinct. A similar, but distinct, deficit called color agnosia exists in which a person has intact color perception but has deficits in color recognition, such as knowing which color they are looking at.

<span class="mw-page-title-main">Quadrantanopia</span> Loss of vision in a quarter of the visual field

Quadrantanopia,quadrantanopsia, refers to an anopia affecting a quarter of the visual field.

Pure alexia, also known as agnosic alexia or alexia without agraphia or pure word blindness, is one form of alexia which makes up "the peripheral dyslexia" group. Individuals who have pure alexia have severe reading problems while other language-related skills such as naming, oral repetition, auditory comprehension or writing are typically intact.

<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.

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.

Prism adaptation is a sensory-motor adaptation that occurs after the visual field has been artificially shifted laterally or vertically. It was first introduced by Hermann von Helmholtz in late 19th-century Germany as supportive evidence for his perceptual learning theory. Since its discovery, prism adaptation has been suggested to improve spatial deficits in patients with unilateral neglect.

Cerebral diplopia or polyopia describes seeing two or more images arranged in ordered rows, columns, or diagonals after fixation on a stimulus. The polyopic images occur monocular bilaterally and binocularly, differentiating it from ocular diplopia or polyopia. The number of duplicated images can range from one to hundreds. Some patients report difficulty in distinguishing the replicated images from the real images, while others report that the false images differ in size, intensity, or color. Cerebral polyopia is sometimes confused with palinopsia, in which multiple images appear while watching an object. However, in cerebral polyopia, the duplicated images are of a stationary object which are perceived even after the object is removed from the visual field. Movement of the original object causes all of the duplicated images to move, or the polyopic images disappear during motion. In palinoptic polyopia, movement causes each polyopic image to leave an image in its wake, creating hundreds of persistent images (entomopia).

<span class="mw-page-title-main">Visual pathway lesions</span> Overview about the lesions of visual pathways

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. Peli E. Field expansion for homonymous hemianopia by optically induced peripheral exotropia. Optom Vis Sci 2000; 77:453-464.
  2. Prism Glasses Expand The View For Patients With Hemianopia, Medical News today, 14 May 2008, www.medicalnewstoday.com/articles/107160.php
  3. Oliver Sacks, The Man Who Mistook His Wife for a Hat
  4. Parton, A; Malhotra, P; Husain, M (2004). "Hemispatial neglect". Journal of Neurology, Neurosurgery, and Psychiatry. 75 (1): 13–21. PMC   1757480 . PMID   14707298.
  5. Zhang X, Kedar S, Lynn MJ, Newman NJ, Biousse V (March 2006). "Homonymous hemianopias: clinical-anatomic correlations in 904 cases". Neurology. 66 (6): 906–10. doi:10.1212/01.wnl.0000203913.12088.93. PMID   16567710. S2CID   72501309.
  6. 1 2 eMedicine > Posterior Cerebral Artery Stroke Authors: Christopher Luzzio and Consuelo T Lorenzo. Updated: Jul 15, 2009
  7. Weinstein, J. M.; Appen, R. E.; Houston, L.; Zurhein, G. (1987). "Recurrent scintillating scotoma and homonymous hemianopia due to metastatic melanoma". Journal of Clinical Neuro-ophthalmology. 7 (3): 155–160. PMID   2958508.
  8. Bowers AR, Keeney K, Peli E. Community-based trial of a peripheral prism visual field expansion device for hemianopia. Arch Ophthalmol 2008;126:657-664