scholarly journals Migraine-Like Positive Visual Phenomena Related to Focal Cortical Lesions with Undetectable Visual Field Defects

2021 ◽  
pp. 653-658
Author(s):  
Amir Vosoughi ◽  
Andrew Micieli ◽  
Jonathan A. Micieli
Keyword(s):  
Visual Field ◽  
Visual Fields ◽  
Occipital Lobe ◽  
Visual Disturbance ◽  
Visual Field Defects ◽  
Cortical Lesions ◽  
Visual Aura ◽  
Visual Phenomena ◽  
History Of ◽  
Field Defects

Migraines are commonly associated with a visual aura that has a characteristic clinical presentation. Cortical lesions within or in close proximity to the retrochiasmal visual pathways may also present in a manner that mimics migrainous visual phenomena and, in some cases, may be too small to manifest with a visual field defect on formal testing. We present 4 patients (3 females and 1 male) with an average age of 48.5 (range 28–67) years who had migraine-like visual disturbances related to a right temporal meningioma, occipital cavernoma, occipital lobe infarction, and demyelination in the optic radiations, which was the presenting sign of multiple sclerosis. No patient underwent neurosurgical intervention, and 1 patient (occipital lobe infarct) had complete resolution of the symptom after initial presentation. All patients had normal visual fields at follow-up and no thinning evident on optical coherence tomography. Our cases emphasize the importance of a history in assessing patients with transient positive visual phenomena and identify pathology that may present without visual field defects. Clinical features that should raise a doubt about a diagnosis of migraine visual aura include the absence of headache, brief visual disturbance lasting <5 min or those lasting >60 min, and age >40, especially with no past medical history of migraine.

Improvement of visual field defects after focal resection for occipital lobe epilepsy: case report

2018 ◽  
Vol 128 (3) ◽  
pp. 862-866 ◽  
Author(s):  
Takahiro Yamamoto ◽  
Tadashi Hamasaki ◽  
Hideo Nakamura ◽  
Kazumichi Yamada
Keyword(s):  
Visual Cortex ◽  
Visual Field ◽  
Occipital Lobe ◽  
Neurological Deficits ◽  
Visual Field Defects ◽  
Epileptic Focus ◽  
Visual Aura ◽  
Occipital Lobe Epilepsy ◽  
The Right ◽  
Field Defects

Improvement of visual field defects after surgical treatment for occipital lobe epilepsy is rare. Here, the authors report on a 24-year-old man with a 15-year history of refractory epilepsy that developed after he had undergone an occipital craniotomy to remove a cerebellar astrocytoma at the age of 4. His seizures started with an elementary visual aura, followed by secondary generalized tonic-clonic convulsion. Perimetry revealed left-sided incomplete hemianopia, and MRI showed an old contusion in the right occipital lobe. After evaluation with ictal video-electroencephalography, electrocorticography, and mapping of the visual cortex with subdural electrodes, the patient underwent resection of the scarred tissue, including the epileptic focus at the occipital lobe. After surgery, he became seizure free and his visual field defect improved gradually. In addition, postoperative 123I-iomazenil (IMZ) SPECT showed partly normalized IMZ uptake in the visual cortex. This case is a practical example suggesting that neurological deficits attributable to the functional deficit zone can be remedied by successful focal resection.

Arteriovenous malformations in the optic apparatus: systematic literature review and report of four cases

2021 ◽  
pp. 1-11
Author(s):  
Visish M. Srinivasan ◽  
Phiroz E. Tarapore ◽  
Stefan W. Koester ◽  
Joshua S. Catapano ◽  
Caleb Rutledge ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Visual Function ◽  
Arteriovenous Malformations ◽  
Vascular Malformations ◽  
Visual Fields ◽  
Optic Tract ◽  
Visual Disturbance ◽  
Visual Field Defects ◽  
Subtotal Resection

OBJECTIVE Rare arteriovenous malformations (AVMs) of the optic apparatus account for < 1% of all AVMs. The authors conducted a systematic review of the literature for cases of optic apparatus AVMs and present 4 cases from their institution. The literature is summarized to describe preoperative characteristics, surgical technique, and treatment outcomes for these lesions. METHODS A comprehensive search of the English-language literature was performed in accordance with established Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify all published cases of AVM in the optic apparatus in the PubMed, Web of Science, and Cochrane databases. The authors also searched their prospective institutional database of vascular malformations for such cases. Data regarding the clinical and radiological presentation, visual acuity, visual fields, extent of resection, and postoperative outcomes were gathered. RESULTS Nine patients in the literature and 4 patients in the authors’ single-surgeon series who fit the inclusion criteria were identified. The median age at presentation was 29 years (range 8–39 years). Among these patients, 11 presented with visual disturbance, 9 with headache, and 1 with multiple prior subarachnoid hemorrhages; the AVM in 1 case was found incidentally. Four patients described prior symptoms of headache or visual disturbance consistent with sentinel events. Visual acuity was decreased from baseline in 10 patients, and 11 patients had visual field defects on formal visual field testing. The most common visual field defect was temporal hemianopia, found in one or both eyes in 7 patients. The optic chiasm was affected in 10 patients, the hypothalamus in 2 patients, the optic nerve (unilaterally) in 8 patients, and the optic tract in 2 patients. Six patients underwent gross-total resection; 6 patients underwent subtotal resection; and 1 patient underwent craniotomy, but no resection was attempted. Postoperatively, 9 of the patients had improved visual function, 1 had no change, and 3 had worse visual acuity. Eight patients demonstrated improved visual fields, 1 had no change, and 4 had narrowed fields. CONCLUSIONS AVMs of the optic apparatus are rare lesions. Although they reside in a highly eloquent region, surgical outcomes are generally good; the majority of patients will see improvement in their visual function postoperatively. Microsurgical technique is critical to the successful removal of these lesions, and preservation of function sometimes requires subtotal resection of the lesion.

Influence of Carteolol and Timolol on IOP and Visual Fields in Glaucoma: A Multi-Center, Double-Masked, Prospective Study

1992 ◽  
Vol 2 (4) ◽  
pp. 169-174 ◽  
Author(s):  
J. Flammer ◽  
Y. Kitazawa ◽  
L. Bonomi ◽  
B. Mills ◽  
M. Fsadni ◽  
...  
Keyword(s):  
Visual Field ◽  
Prospective Study ◽  
Beta Blockers ◽  
Visual Fields ◽  
Visual Field Defects ◽  
Eye Drops ◽  
Treatment Groups ◽  
Visual Field Damage ◽  
One Year ◽  
Field Defects

The influences of Carteolol and Timolol eye drops on intraocular pressure (IOP) and visual fields were compared in a multi-center, double-masked, prospective study. Two-hundred and forty eyes of 120 patients were initially included in the study, and 142 eyes of 72 patients fulfilled all the criteria for final statistical analysis. Both drugs significantly reduced IOP. The visual fields in both treatment groups did not change during one year of treatment. In both groups some patients improved slightly, and others deteriorated slightly. This indicates that locally applied beta-blockers may efficiently stop further progression of visual field defects in cases with increased IOP and early visual field damage. There was no difference between Carteolol and Timolol in this regard. The side effects were minimal, and there were no differences in their frequency or intensity in the two treatment groups.

Reading with Visual Field Defects

Perception ◽  
1997 ◽  
Vol 26 (1_suppl) ◽  
pp. 11-11 ◽  
Author(s):  
S Trauzettel-Klosinski
Keyword(s):  
Eye Movements ◽  
Visual Field ◽  
Reading Ability ◽  
Reading Speed ◽  
Visual Fields ◽  
Zero Point ◽  
Normal Subjects ◽  
Visual Field Defects ◽  
Video Tape ◽  
Field Defects

The influence of different visual field defects on the reading performance was examined with potential adaptive strategies to improve the reading process in mind. By means of an SLO, the retinal fixation locus (RFL) was determined with the use of single targets and text, and eye movements scanning the text were recorded on video tape. Additionally, eye movements were monitored by an Infrared Limbus Tracker. Visual fields were assessed by the Tübingen Manual and/or automatic perimetry. Normal subjects, and patients with central scotomata, ring scotomata, and hemianopic field defects (HFD) were examined. The main pathological reading parameters were an increase of saccade frequency and regressions per line, and a decrease of reading speed. In patients with field defects involving the visual field centre, fixation behaviour is significant for regaining reading ability. In absolute central scotoma, the lost foveal function promotes eccentric fixation. The remaining problem is insufficient resolution of the RFL, which can be compensated for by magnification of the text. In patients with insufficient size of their reading visual field, due to HFD and ring scotoma, it is crucial that they learn to use a new RFL despite intact foveolar function. Preconditions for reading have been found to be: (1) sufficient resolution of the RFL, (2) a reading visual field of a minimum extent, and (3) intact basic oculomotor function. In patients with visual field defects involving the centre, a sensory-motor adaptation process is required: the use of a new RFL as the new centre of the visual field and as the new zero point for eye-movement coordinates.

Transitory and permanent visual field defects induced by occipital lobe seizures

1999 ◽  
Vol 20 (5) ◽  
pp. 321-325 ◽  
Author(s):  
G. Valli ◽  
S. Zago ◽  
A. Cappellari ◽  
A. Bersano
Keyword(s):  
Visual Field ◽  
Occipital Lobe ◽  
Visual Field Defects ◽  
Field Defects

Normal visual fields as assessed by computerized static threshold perimetry in patients with untreated primary hypothyroidism

1989 ◽  
Vol 121 (4) ◽  
pp. 495-500 ◽  
Author(s):  
Bengt Hallengren ◽  
Per Manhem ◽  
Margareta Bramnert ◽  
Inga Redlund-Johnell ◽  
Anders Heijl
Keyword(s):  
Visual Field ◽  
Prospective Study ◽  
Visual Fields ◽  
Primary Hypothyroidism ◽  
Common Finding ◽  
Visual Field Defects ◽  
Computer Assisted ◽  
Computerized Perimetry ◽  
Assisted Analysis ◽  
Field Defects

Abstract. In this prospective study, 25 consecutive patients with untreated primary hypothyroidism were tested with a highly sensitive perimetric technique, since a high prevalence of visual field defects has been described in this condition. All patients had clinical hypothyroidism, a serum TSH value > 20 mU/l (reference range 0.4–4.0) and decreased/low normal serum total T4 concentration. Visual fields were tested with fully automated threshold-measuring computerized perimetry of the central 30 degrees field. Interpretation of fields included computer-assisted analysis provided by a perimetric statistical programme package. In 23 patients, conventional inspection and computer-assisted analysis showed no visual field defects. Two patients were excluded from the latter analysis: one patient who did not respond adequately at computerized perimetry and in whom manual field tests were entirely normal; one patient who had low sensitivity values in the uppermost parts of both visual fields owing to markedly swollen upper eye lids. In conclusion, although pituitary hyperplasia has been well documented in primary hypothyroidism, the present prospective study clearly indicates that visual field defects are not a common finding in patients with this disease.

Clinical Study of the Visual Field Defects Caused by Occipital Lobe Lesions

2014 ◽  
Vol 37 (2) ◽  
pp. 102-108 ◽  
Author(s):  
Katsuhiko Ogawa ◽  
Hiroshi Ishikawa ◽  
Yutaka Suzuki ◽  
Minoru Oishi ◽  
Satoshi Kamei
Keyword(s):  
Clinical Study ◽  
Visual Field ◽  
Occipital Lobe ◽  
Visual Field Defects ◽  
Field Defects

Retrogeniculate Visual Field Defects

Visual Fields ◽  
2010 ◽  
Author(s):  
Thomas R. Hedges III
Keyword(s):  
Visual Field ◽  
Vision Loss ◽  
Visual Fields ◽  
Field Testing ◽  
Visual Field Defects ◽  
Automated Perimetry ◽  
Loss Of Vision ◽  
Data Points ◽  
Field Defects ◽  
Macular Sparing

Automated perimetry has changed visual field testing considerably in recent years. What was considered an art has become an exercise in interpreting a set of data points obtained mechanically. Automated perimetry saves ophthalmologists time, which ideally should allow for more visual fields to be obtained on patients with unexplained vision loss. However, one must still keep in mind that automated perimetry still depends on the subjective responses from the patient. More important, automated perimetry has made interpretation of visual field defects, especially those due to occipital lesions, more difficult. For example, macular sparing may not be reflected, especially with programs limited to the central 24° or 30°. A 10° field may be required to show macular sparing. Also, sparing or involvement of the temporal crescent will not be shown with 24° or 30° visual fields. The limitation of most programs may lead to the appearance of incongruity when in fact the field is indeed congruous. Sometimes, a small homonymous hemianopic scotoma will be detected when one eye is tested but will be completely missed when the other eye is tested, giving the false impression that the visual loss is monocular. This is especially problematic if the patient also falsely interprets his or her homonymous loss of vision as monocular. Such individuals may complain of loss of vision in one eye when in fact it is one half of their visual field that is defective. The strategy of automated testing on either side the vertical and horizontal meridians may lead to the false impression that field defects respect the vertical or horizontal meridian when they do not. Automated perimetry should make it possible to test more patients with unexplained vision loss, but all automated visual fields must be interpreted with caution and, when necessary, substantiated with some other method, such as the tangent screen, which remains the most powerful method of detecting the size, shape, and density of visual field defects. Because most ophthalmologists no longer use tangent screen testing, at least an Amlser grid should be used to qualify the nature of a paracentral visual field defect.

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