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An important teaching case
A 45 year old lady with significant vascular risk factors presented with hyperacute onset dimness in the L side of her field of vision, specially in the bottom half.
There is no other significant neurological or systemic hx.
A 45 year old lady with significant vascular risk factors presented with hyperacute onset dimness in the L side of her field of vision, specially in the bottom half.
There is no other significant neurological or systemic hx.
Clinical examination revealed only a BP - 150/90, R arm, sitting position with confrontation perimetry showing an incongruent, incomplete L sided homonymous hemianopia.
A homonymous hemianopia localizes posterior to the optic chiasma where the nasal hemiretinal fibers decussate.
A L sided HH localizes a lesion to the R post-chiasmatic visual pathway.
Incongruency argues for a relatively anterior localization of the lesion ie away from cortex.
A L sided HH localizes a lesion to the R post-chiasmatic visual pathway.
Incongruency argues for a relatively anterior localization of the lesion ie away from cortex.
