Neurological Visual Field Defects

Abstract

Since its introduction in the 19th century perimetry has been used to help localise lesions responsible for visual field defects. In this review the visual field defects produced by lesions at different sites along the neurological visual pathway will be discussed and unusual and challenging visual field defects will be highlighted.

How to interpret visual fields

“…Instead we recommend two excellent recent reviews 1 2. Skilled interpretation of visual field tests requires a good grasp and application of this prior knowledge.…”

Atypical junctional scotoma secondary to optic chiasm atrophy: a case report

“…The most important clinical test to identify suspected optic chiasm pathology is threshold visual field testing, followed by magnetic resonance imaging to localise the suspected lesion . Typical visual field defects that can localise to the optic chiasm are: bitemporal hemianopias, bitemporal quadrantanopsia, homonymous hemianopias, and junctional scotomas . Junctional scotomas are defined as: ipsilateral central scotoma and contralateral temporal visual field loss/depression, classically in the superior temporal quadrant .…”

“…Typical visual field defects that can localise to the optic chiasm are: bitemporal hemianopias, bitemporal quadrantanopsia, homonymous hemianopias, and junctional scotomas . Junctional scotomas are defined as: ipsilateral central scotoma and contralateral temporal visual field loss/depression, classically in the superior temporal quadrant . Junctional scotomas have been reported to occur in approximately 13 per cent of chiasm syndromes .…”

“…Further, a newer study has found that the nasal retinal fibres cross more posteriorly in the superior parts of the chiasm and more anteriorly in the inferior parts . Given the level of sophistication of optic chiasm anatomy, lesions here can produce a variety of visual field defects and/or vision loss depending on the size and location of the lesion in the chiasm, as described in this case of a junctional scotoma secondary to optic chiasm atrophy …”

Homonymous Sectoranopia: Asymptomatic Presentation of a Lateral Geniculate Nucleus Lesion

“…Most of the reported cases of sectorial sectoranpia occurred as a result of a vascular insult. Although sectoranopia [4][5][6][7][8] is typically associated with lesions of the LGN, a few cases have been reported as a result of lesions affecting the temporo-occipital or parietooccipital lobes 9 as well as optic tract lesions 10 and lesions involving the primary visual cortex with the calcarine fissure. 11 However, in this case, the pattern of retinal nerve fibre layer atrophy suggested a left-sided damage to second-order neurons behind the chiasm at the level of either the optic tract or LGN.…”