A Case of Functional Bitemporal Hemianopia Respecting the Vertical Meridian

Sang Beom Han; Jeong-Min Hwang

doi:10.3341/jkos.2009.50.6.957

Journal List > J Korean Ophthalmol Soc > v.50(6) > 1008593

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Han and Hwang: A Case of Functional Bitemporal Hemianopia Respecting the Vertical Meridian

Original Article

J Korean Ophthalmol Soc 2009;50(6):957-962.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.6.957

A Case of Functional Bitemporal Hemianopia Respecting the Vertical Meridian

Sang Beom Han, MD^1,², Jeong-Min Hwang, MD^1,²

¹Department of Ophthalmology, Seoul National University School of Medicine, Seoul, Korea

²Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea

Address reprint requests to Jeong-Min Hwang, MD Department of Opthalmology, Seoul National University Bundang Hospital #300 Gumi-dong, Bundang-gu, Seongnam 463-707, Korea Tel: 82-31-787-7372, Fax: 82-31-787-4057, E-mail: hjm@snu.ac.kr

Received 7 August 2008 Accepted 4 February 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report a case of functional bilateral hemianopia which was not associated with any organic causes.

Case summary

A 35-year-old female patient presented with bilateral disturbance of visual acuity and visual field, which had begun 8 months prior. Goldmann perimetry showed bitemporal hemianopsia respecting the vertical meridian. Pupillary response was normal, and the anterior segment, fundus, and optic nerve were also normal bilaterally. However, the tangent screen test and Humphrey visual field test showed a widening of hemianopia not respecting the vertical meridian, and the crossing of isopters at 1 m and 2 m with the tangent screen test. In addition, multifocal electroretinogram and multifocal visual evoked potential did not reveal any abnormal findings corresponding to the bitemporal hemianopia. Brain magnetic resonance imaging showed no abnormal findings in the orbit and brain.

Conclusions

Bitemporal hemianopsia can be developed functionally, although it may be rare. Repetition of various visual field tests and use of multifocal electrophysiologic studies can be helpful in the differential diagnosis.

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Keywords: Bitemproal hemianopia, Functional visual field defect, Multifocal electrophysiologic study

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Figure 1.

(A) Fundus photography showed normal optic disc and fundus in both eyes. (B) Multifocal visual evoked potential revealed that there was neither interocular nor nasal-temporal difference in the response in both eyes. (C) Multifocal electroretinogram did not show any abnormal naso–temporal differences in amplitude or latency in both eyes (R: right, L: left).

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Figure 2.

(A) Goldmann visual field test showed bitemporal hemianopia respecting the vertical meridian. (B) Humphrey visual field test showed bilateral temporal visual field defect not respecting the vertical meridian. (C) Tangent screen test did not show the bitemporal hemianopia detected in Goldmann visual field test. The visual field at 1 m (red line) and 2 m (blue line) crossed in the right eye and the visual field at 2 m (blue line) is smaller than that at 1 m (red line) in the left eye, suggesting the functional visual loss (R: right, L: left).

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Figure 3.

Brain magnetic resonance imaging with contrast did not show any abnormal findings around the optic chiasm (A: a fluid-attenuated inversion-recovery (FLAIR) image, transverse section, B: a FLAIR image, sagittal section).

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