Quadruple sectoranopia and sectorial optic atrophy: a syndrome of the distal anterior choroidal artery.

Abstract

SUMMARY Loss of upper and lower homonymous sectors in the visual field, and wasting of corresponding sectors in the retinal nerve fibre layer, followed ligation of the distal part of the anterior choroidal artery in a patient with a meningioma of the velum interpositum. Clinical and radiological evidence indicated that the visual pathway was damaged within that part of the lateral geniculate body that is served by the anterior choroidal artery.A syndrome of sectorial optic atrophy and homonymous, horizontal sectoranopia has recently been described in this journal, and attributed to infarction of the territory of the lateral choroidal artery in the dorsal lateral geniculate nucleus (LGN) (Frisen et al., 1978 vessels coming from the distal anterior choroidal artery, which was strikingly dilated (Fig. 1A). Other portions of the tumour were fed from small tortuous vessels coming from the carotid syphon and branches of the middle cerebral artery. There was neither arteriovenous shunting nor filling from external carotid artery branches. The findings were considered compatible with an intraventricular meningioma.A preoperative neuro-ophthalmological examination showed a complete left homonymous hemianopia. Optokinetic stimulation gave a less vigorous response when the drum was rotated towards the right. Both optic nerve heads were swollen, protruding about three dioptres. The cup of the optic disc was nearly obliterated, but only short vascular segments were obscured by overlying oedema. There was a moderate degree of hyperaemia, a few yellow spots, and a few thin splinter haemorrhages at the disc borders. No other abnormalities were seen.

MRI of hyperacute stroke in the AChA territory

“…Tables 1 and 2 list the major anatomy [1][2][3][4][5][6][7][8][9][10][11][12][13][24][25][26] and pathology [18][19][20][21][22][23][27][28][29][30][31][32][33] (Fig. 1).…”

“…CT and MRI are the two major imaging modalities used for the diagnosis of acute ischemic stroke [15][16][17]. Frisen and colleagues first showed the CT appearance of ischemia involving the AChA territory [18]. Since then, several studies have dealt with the clinical-radiological correlates in AChA infarction [19,20].…”

Posterior Choroidal-Artery Infarct with Homonymous Horizontal Sectoranopia

“…In these persons, an infarction in the posterior choroidal-artery region will yield homonymous horizontal sectoranopia, as in our patient. On the other hand, an infarct in the anterior choroidal-artery region involving the lateral geniculate body may induce quadruple sectoranopia sparing the middle horizontal sector of the visual field [13]. The lateral geniculate body is somewhat unique in that this body is irrigated by branches coming both from the vertebro-basilar (posterior choroidal artery) and ca rotid system (anterior choroidal artery).…”

Vertebrobasilar Occlusive Disease: Review of Selected Aspects

“…Lesions of the anterior cho roidal artery artery, which also supplies the lateral genicu late body usually give rise to the mirror image field defect, i.e. a so-called quadruple homonymous scctoranopia in volving the upper and lower Helds but sparing a wedge in the horiz.ontai median region [81][82][83].…”