Recovery of Visual Fields in Acute Stroke: Homonymous Hemianopia Associated with Adverse Prognosis

Abstract

In a prospective study of 157 patients (median age 73 years) admitted to hospital within 72 hours of acute cerebral hemisphere stroke, there was clinical evidence of homonymous hemianopia (HH) as assessed by confrontation in 99 (63%). Patients were followed with serial neurological examinations for 28 days. Complete recovery of visual fields occurred in 14 (17%) of the 81 patients with a complete HH on admission and in 13 (72%) of the 18 patients with a partial HH on admission. Cumulative fatality at 28 days was greater in patients with a complete HH (49%), compared with patients with a partial HH (11%). These two patterns of recovery and outcome probably reflect the differing extent of cerebral damage in the two groups.

Intravenous Thrombolysis in Ischemic Stroke Patients With Isolated Homonymous Hemianopia

“…13 However, as many as 46% and 67% of hemianopes of vascular origin (both ischemic and hemorrhagic stroke) in the occipital lobe improved in a series of 69 and 99 patients. 4,16 None of the aforementioned studies included thrombolysis-treated patients.…”

“…However, more reliable ophthalmological perimetry of stroke patients is difficult during the first month. 4 Furthermore, site of occlusion is not available in the SITS registry. We could not strictly compare our results with historical controls because previous reports included heterogeneous patient populations and report different outcome measures.…”

“…Hemianopia of vascular origin has the worst prognosis for spontaneous recovery. 3,4 We previously identified 3 patients with isolated homonymous hemianopia among 1427 intravenous thrombolysis-treated stroke patients in the Helsinki Stroke Thrombolysis Registry and reported excellent outcomes in all of them. 5 Therefore, we aimed to analyze the same phenomenon in the largest stroke thrombolysis database, the Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register (SITS-ISTR).…”

A Randomised Controlled Trial of Treatment for Post-Stroke Homonymous Hemianopia: Screening and Recruitment

“…[2][3][4][5] If a patient recovers, this is usually by 3 months and may be full, with a return of normal visual fields in up to 44%, or partial recovery in up to 72%. 2,[6][7][8][9][10][11][12] Where homonymous hemianopia persists, it has considerable impact to daily life. Studies that have addressed this impact report a loss of confidence, increased accidents, and collisions, reading difficulties, navigation issues, loss of driving, and issues with isolation.…”

Recovery of Visual Field Defect via Corpus Callosum in a Patient with Cerebral Infarct

“…1,2 Although the incidence of visual field defect in stroke patients is high, a considerable portion of these patients show recovery of visual field defect: in detail, Gray et al reported that among 99 patients who developed homonymous hemianopia within 72 hours of stroke onset, complete visual field recovery was observed within 28 days in 14 (17%) of 81 patients with complete homonymous hemianopia and in 13 (72%) of 18 patients with partial homonymous hemianopia. [2][3][4] However, the recovery mechanism of visual field defect in stroke patients has not been clearly elucidated, although a few studies have reported on recovery of injured OR. [5][6][7] On the other hand, many studies have reported that the corpus callosum connects both occipital lobes and callosal connections represent a major pathway in induction of plastic rearrangements in the visual cortex.…”