Analysis of Visual Field Defect in Patient with Brain Lesion

Kyoung Yoon Shin; Sung Eun Kyung

doi:10.3341/jkos.2015.56.9.1339

Journal List > J Korean Ophthalmol Soc > v.56(9) > 1010091

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Shin and Kyung: Analysis of Visual Field Defect in Patient with Brain Lesion

Original Article

J Korean Ophthalmol Soc 2015;56(9):1439-1445.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.9.1339

Analysis of Visual Field Defect in Patient with Brain Lesion

Kyoung Yoon Shin, M.D., Sung Eun Kyung, M.D., PhD

Department of Ophthalmology, Dankook University Medical College, Cheonan, Korea

Address reprint requests to Sung Eun Kyung, MD, PhD Department of Ophthalmology, Dankook University Hospital, #201 Manghyang-ro, Dongnam-gu, Cheonan 31116, Korea Tel: 82-41-550-6497, Fax: 82-41-550-0137 E-mail: kseeye@hanmail.net

Received 27 February 20156 May 2015 Accepted 6 July 2015

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

In this study we analyzed the results of visual field tests in patients diagnosed with a brain lesion in an ophthalmology clinic.

Methods

The medical records of 55 patients who underwent visual field examinations and diagnosed with brain pathology using magnetic resonance imaging (MRI) from January 1, 2005 to June 30, 2014 were retrospectively investigated.

Results

Of the 55 patients (M:F = 30:25), 31 displayed symmetrical hemianopsia, a typical visual field defect associated with brain lesions. Twenty-four patients showed atypical visual field defect (20 showed normal visual field despite the brain lesion, 3 had bilateral narrowing of the peripheral visual field in 2 cerebral infarctions and 1 multiple sclerosis, and 1 had horizontal inferior visual field defect in 1 eye from nasopharyngeal cancer).

Conclusions

Patients having a brain lesion with the optic tract invasion may present with atypical visual field defects. The periph-eral visual field constriction and horizontal inferior visual field defect in 1 eye could be the visual field defect in patients with a brain lesion.

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Keywords: Brain lesion, Optic tract, Visual field defect

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Figure 1.

The brain magnetic resonance image and visual field exam of a pituitary adenoma patient.(A)The magnetic resonance image shows the dumbbell shape mass compressing the left optic chiasm. The optic chiasm is displaced to the left side. (B,C) The visual field shows the crossed bitemporal quadrantanopia.

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Figure 2.

The pathway of retinal fibers in optic chiasm. Dotted line and full line show retinal fibers pathway. (A) The optic nerve and decussation of crossing nasal retinal fibers in the chiasm. (B) The mass in the chiasm compressing left Wilbrands knees produce right superotemporal and left inferotemporal visual field defect (crossed bitemporal quadrantanopia-Fig. 1B, 1C).

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Figure 3.

The brain magnetic resonance image and visual field exam of a multiple myeloma patient. (A) Multifocal bilateral asymmetric T2 hyperintense lesions with enhancement in subcortical and deep white matter of cingulate gyri. (B) The brain magnetic resonance image of different level. (C) The visual field shows peripheral visual field constriction in left eye. (D)The visual field shows peripheral visual field constriction in right eye.

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Figure 4.

The brain magnetic resonance image, visual field exam and fluorescein angiography photo of a nasopharyngeal cancer patient. (A) Coronal magnetic resonance image showed enlarged left cavernous sinus with enhancement, narrowing left distal ICA, and dural enhancement (arrowhead). (B) Magnetic resonance angiography showed the narrowing of left distal ICA (arrowhead). Humphrey field analysis SITA-standard 30-2 in left eye. At first visit. (C) Visual field showed inferior visual field defect. (D) Three months later, visual fields were aggravated and involved the central area diffusely. (E) Fluorescein angiography showed delayed central arterial phase at 26.9 seconds. (F) Fluorescein angiography showed delayed central arterial phase at 28.1 seconds. ICA = internal carotid artery; SITA = Swedish interactive thresholding algorithm.

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