Homonymous hemianopia in multiple sclerosis. With report of bilateral case.

Abstract

Optic neuritis is common in multiple sclerosis, occurring in 22-83 per cent ofpatients (Carter, Sciarra, and Merritt, I950; Chamlin, 1953; Leinfelder, 1950;Marshall, 1950; Savitsky and Rangell, I95oa; Zeller, I967 Ronne, 1912, 19I5; Traquair, I942; Vedel-Jensen, 1959), and other unspecified types of homonymous defects (Croll, i965; Kurtzke, Beebe, Nagler, Auth, Kurland, and Nefzger, I968; Leinfelder, 1950; MUller, 1949) Savitsky and Rangell, 195ob). One of Bielschowsky's cases had bilateral involvement at different times (Bielschowsky, 1933).We reviewed the records of 344 patients all of whom had been discharged from the ColumbiaPresbyterian Medical Center from I962 to 1970 with a diagnosis of multiple sclerosis. In 300 of these, the diagnosis was considered to be valid on the basis of characteristic clinical presentation and course. Among these patients there were 40 with observed optic neuritis, 83 with history suggestive of optic neuritis, and 5 I without such a history but with optic disc pallor. In the entire group of 300 patients, only four had homonymous visual field defects, an incidence of I-3 per cent.A patient was recently seen with simultaneous bilateral homonymous hemianopic defects. This unique case is reported in detail and the infrequent (Figure).

Homonymous Hemianopsia as the Initial Manifestation of Multiple Sclerosis

“…Suprageniculate lesions generally manifest as visual field defects and these are probably related to subclinical optic neuritis [1, 6]. There was a deeper defect in the midperiphery than in the central visual field in this case.…”

“…The frequency of homonymous visual field defects in multiple sclerosis (MS) has been reported to be 1.3–3.5% [1, 2]. The onset of MS as homonymous hemianopsia due to a suprageniculate lesion of the visual pathways is rare.…”

Ocular Manifestations in Korean Patients with Multiple Sclerosis

“…The frequency of homonymous visual field defects in MS has been reported to be 1% in Kahana's study, 43 1.3% in Hawkins' study, 44 3.5% in Boldt's study, 45 respectively. Tsuda et al 10 stated that homonymous hemianopia was detected in 2.5%, and completely resolved after corticosteroid therapy.…”

Visual pathway abnormalities were found in most multiple sclerosis patients despite history of previous optic neuritis

“…Optical radiation consists of large axons with thick myelin sheaths and low fiber density with wide translucent space 18 , different from the optic nerve fibers which are concentrated in a relatively small volume. This distribution of the fibers, the redundancy and plasticity of the posterior pathway, the possibility of demyelination without detectable axonal conduction deficit and the tendency for inflammation in MS to be centered around venules and not fiber tracts 19 , all these factors may explain the difficulty to correlate neuroimaging and clinical data.…”