J Korean Ophthalmol Soc.  2015 Sep;56(9):1439-1445. 10.3341/jkos.2015.56.9.1439.

Analysis of Visual Field Defect in Patient with Brain Lesion

• Shin KY
• Kyung SE

• KMID: 2214561
• DOI: http://doi.org/10.3341/jkos.2015.56.9.1439

Abstract

PURPOSE
In this study we analyzed the results of visual field tests in patients diagnosed with a brain lesion in an ophthalmology clinic.
METHODS
The medical records of 55 patients who underwent visual field examinations and diagnosed with brain pathology using magnetic resonance imaging (MRI) from January 1, 2005 to June 30, 2014 were retrospectively investigated.
RESULTS
Of the 55 patients (M:F = 30:25), 31 displayed symmetrical hemianopsia, a typical visual field defect associated with brain lesions. Twenty-four patients showed atypical visual field defect (20 showed normal visual field despite the brain lesion, 3 had bilateral narrowing of the peripheral visual field in 2 cerebral infarctions and 1 multiple sclerosis, and 1 had horizontal inferior visual field defect in 1 eye from nasopharyngeal cancer).
CONCLUSIONS
Patients having a brain lesion with the optic tract invasion may present with atypical visual field defects. The peripheral visual field constriction and horizontal inferior visual field defect in 1 eye could be the visual field defect in patients with a brain lesion.

Keyword

Brain lesion; Optic tract; Visual field defect

MeSH Terms

Brain Diseases
Brain*
Cerebral Infarction
Constriction
Hemianopsia
Humans
Magnetic Resonance Imaging
Medical Records
Multiple Sclerosis
Ophthalmology
Retrospective Studies
Visual Field Tests
Visual Fields*
Visual Pathways

Figure

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  Figure 1. The brain magnetic resonance image and visual field exam of a pituitary adenoma patient.(A)The magnetic resonance image shows the dumbbell shape mass compressing the left optic chiasm. The optic chiasm is displaced to the left side. (B,C) The visual field shows the crossed bitemporal quadrantanopia.

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  Figure 2. The pathway of retinal fibers in optic chiasm. Dotted line and full line show retinal fibers pathway. (A) The optic nerve and decussation of crossing nasal retinal fibers in the chiasm. (B) The mass in the chiasm compressing left Wilbrands knees produce right superotemporal and left inferotemporal visual field defect (crossed bitemporal quadrantanopia-Fig. 1B, 1C).

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  Figure 3. The brain magnetic resonance image and visual field exam of a multiple myeloma patient. (A) Multifocal bilateral asymmetric T2 hyperintense lesions with enhancement in subcortical and deep white matter of cingulate gyri. (B) The brain magnetic resonance image of different level. (C) The visual field shows peripheral visual field constriction in left eye. (D)The visual field shows peripheral visual field constriction in right eye.

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  Figure 4. The brain magnetic resonance image, visual field exam and fluorescein angiography photo of a nasopharyngeal cancer patient. (A) Coronal magnetic resonance image showed enlarged left cavernous sinus with enhancement, narrowing left distal ICA, and dural enhancement (arrowhead). (B) Magnetic resonance angiography showed the narrowing of left distal ICA (arrowhead). Humphrey field analysis SITA-standard 30-2 in left eye. At first visit. (C) Visual field showed inferior visual field defect. (D) Three months later, visual fields were aggravated and involved the central area diffusely. (E) Fluorescein angiography showed delayed central arterial phase at 26.9 seconds. (F) Fluorescein angiography showed delayed central arterial phase at 28.1 seconds. ICA = internal carotid artery; SITA = Swedish interactive thresholding algorithm.

Reference

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