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Hemianopsia (and Scotoma)
Published in Alexander R. Toftness, Incredible Consequences of Brain Injury, 2023
Hemianopsia (also spelled hemianopia) is a type of partial blindness that affects half of a person's vision. This partial blindness can be annoying, such as when this affects a person's ability to read, and it can be dangerous, when affecting a person's ability to navigate around objects or avoid falling over (Goodwin, 2014). There are several types of hemianopsia, and they all have long names that can take some getting used to.
Cortical Visual Loss
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
The hemifield defects from striate damage are highly congruent. Complete hemianopia is possible but partial defects are common. Sparing of the occipital pole causes a macula-sparing hemianopia (preservation of the central 5°) (32, 33), while sparing of the most anterior striate cortex results in sparing of the monocular temporal crescent (34, 35). A retrosplenial lesion could cause the converse, a monocular temporal crescentic scotoma only (36), but this is rare. Damage to the lower bank will cause a superior quadrantanopia and damage to the upper bank an inferior quadrantanopia. Empirically, a quadrantic defect is more likely to represent striate damage than a lesion of the optic radiations (24). Striate quadrantanopia is more frequently an isolated sign or else accompanied by other visual dysfunction, such as alexia or hemi-achromatopsia, whereas a quadrantanopia from optic radiation damage usually occurs with hemiparesis, dysphasia, or amnesia (24). Small lesions that may be missed on routine MR imaging (32) can cause homonymous scotomata: small occipital pole infarcts (Figure 20.4b) can cause hemi-macular scotomata (33), and more anterior lesions cause more peripheral scotomata.
Degenerative Diseases of the Nervous System
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
James A. Mastrianni, Elizabeth A. Harris
Pallidotomy: Lesions in the posteroventral portion of the GPi presumably reduce the inhibitory output from the medial globus pallidus and thereby improve many of the ‘off’ period symptoms of PD (tremor, rigidity, and bradykinesia on the side contralateral to the surgery and some elements of gait). Lesions may also reduce levodopa-induced dyskinesias by up to 75%.However, they do not improve the patient's level of function when ‘on’ except for elimination of peak-dose levodopa-induced dyskinesias. Midline symptoms, such as postural instability and abnormal gait, also improve less. Any improvements are immediate and sustained for at least 6 months.Complications include homonymous hemianopia (up to 14%), facial paresis (up to 51%), and hemiparesis (up to 4%).
The impact of low vision on activities, participation, and goals among older adults: a scoping review
Published in Disability and Rehabilitation, 2022
Debbie Boey, Tamara Tse, Yi hui Lim, Mei Leng Chan, Kerry Fitzmaurice, Leeanne Carey
Of the studies that addressed mobility, seven studies compared the walking performance of older adults with low vision with a control group, with six reporting statistically significant differences. Participants with AMD had slower gait speed [37] and poorer mobility [35]. Participants with hemianopia had poorer outcomes in the categories of Moving, Moving around different locations, and Using transportation [34]. Participants with hemianopia and with impairments in visual acuity had significantly lower outcomes in driving and the distant activity domain of the NEI-VFQ-25, which included mobility, compared to controls [30,34]. One study that did not identify a significant difference compared to controls in the categories of walking, moving around and moving around in different locations included participants with diabetic retinopathy [31]. Two longitudinal cohort studies investigated mobility in older adults with low vision. One study found that after five years of follow-up, individuals with low vision visual acuity had a greater risk of walking and stair climbing limitations than those without low vision [28]. In the other cohort study, those with visual impairment reported more mobility difficulties than the non-visually impaired at baseline, but the difference between the two groups declined at eight years which may be due to the loss of visually impaired participants at risk of developing mobility difficulties [27].
Managing pregnancy in women with Sturge-Weber syndrome: case report and review of the literature
Published in Journal of Obstetrics and Gynaecology, 2022
Vignesh Durai, Haritha Sagili, Jayalakshmi Durairaj, Ramesh Ananthakrishnan, Pradeep P. Nair, Arun Keepanasseril, Anish Keepanasseril
Intracranial angiomatosis, usually unilateral, may present with seizures in the first 2 years of life; rarely, it may be delayed until adulthood. Most are diagnosed at birth following evaluation for PWS and seizures (Table 1) (Sudarsanam and Ardern-Holmes 2014). Typically, these are focal motor type seizures that may evolve to generalised tonic-clonic seizures. Other presentations include migraine-like headaches, cognitive impairments, stroke-like episodes and rarely endocrine problems such as central hypothyroidism (Bebin and Gomez 1988). Due to its association with glaucoma, assessment of intraocular pressure, perimetry, and a slit lamp examination of eyes need to be performed early during booking to plan further follow up during pregnancy and postpartum (Sujansky and Conradi 1995; Sudarsanam and Ardern-Holmes 2014). Three among reported cases had associated visual defects (reduced vision and hemianopia).
Multisensory stimulation for the rehabilitation of unilateral spatial neglect
Published in Neuropsychological Rehabilitation, 2021
Luca Zigiotto, Alessio Damora, Federica Albini, Carlotta Casati, Gessica Scrocco, Mauro Mancuso, Luigi Tesio, Giuseppe Vallar, Nadia Bolognini
A series of 20 right-hemisphere-damaged patients (9 men, all right-handed) with left USN participated to the study. Patients were recruited from 3 Italian rehabilitation centres: IRCCS Istituto Auxologico Italiano (Milan), Tuscany Rehabilitation Clinic (Montevarchi, Arezzo), and San Antonio Abate Hospital (Gallarate, Varese). All patients gave their informed consent to the study, which was carried out in accordance with the ethical standards of the World Medical Association (Declaration of Helsinki). The study was approved by the local Ethical Committees. All patients were diagnosed as showing USN according to a standard neuropsychological battery, which included cancellation, line bisection, reading and drawing tasks; the same tests, fully described below, were used to measure clinical improvements brought about by the treatments. Visual field defects were assessed by confrontation testing, as a part of the neurological examination (Bolognini & Vallar, 2020; DeMyer, 2013); none patient showed signs of hemianopia.