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Visual Fields in Neuro-Ophthalmology
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
This chapter will discuss the techniques available to map out the visual field and then the types of visual field defect that may be produced in non-organic (functional) illness and in neuro-ophthalmological disease. Figure 2.1 illustrates the usual visual field defects that can occur with damage to the different sites along the visual pathway. Absolute defects are not always seen. The depth of the defect depends on the degree of damage and the disease process involved.2,3
Cranial Neuropathies II, III, IV, and VI
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Tanyatuth Padungkiatsagul, Heather E. Moss
Generally, three types of visual defects may be seen with optic neuropathies. The most common is generalized constriction of the peripheral field.4 This type of visual field defect can also be caused by other ophthalmic conditions including cataract, retinal degenerations, and nonorganic visual loss. The second type of defect is central visual field loss including central, paracentral, and cecocentral scotomas. These are typically described as a blur, spot, or missing central vision. These also occur in maculopathies. Finally, nerve fiber bundle defects can be seen. They follow the retinotopic pattern of the nerve fibers as they enter the optic nerve, flipped due to the optics of the eye (i.e. superior retina – inferior visual field) (Figure 22.2). They respect the horizontal meridian of the visual field and are termed arcuate defects, nasal steps, or altitudinal defects. This is in contrast to visual field defects due to visual pathway injury at the chiasm or behind the chiasm that respect the vertical meridian (Figure 22.3).
The nervous system
Published in Peter Kopelman, Dame Jane Dacre, Handbook of Clinical Skills, 2019
Peter Kopelman, Dame Jane Dacre
A visual field defect may be due to a lesion affecting the eye or optic nerve, optic chiasm, optic tract between the chiasm and the lateral geniculate bodies, optic radiation or occipital cortex. A diagrammatic outline of the visual pathways is shown in Fig. 6.37. Included in the illustration are the common abnormalities you may encounter and the anatomical location of the various lesions.
Estimation Error Consisting of Motor Imagery and Motor Execution in Patients with Stroke
Published in Journal of Motor Behavior, 2023
Katsuya Sakai, Yuichiro Hosoi, Yusuke Harada, Yumi Ikeda
A total of 60 patients with stroke were enrolled in the study (average age, 66.8 ± 12.8 years; male, n = 37; average time since stroke, 93.0 ± 50.4 days; hemorrhagic, n = 23; infarction, n = 37; right hemiplegia, n = 20; left hemiplegia, n = 40). This study was a cross-sectional study and was conducted in two rehabilitation hospital units between October 2021 and April 2022. The inclusion criteria were (a) diagnosis of first-ever stroke, (b) ability to walk without assistance, (c) age < 18 years, (d) absence of orthopedic disease, and (e) presence of hemiplegia. The exclusion criteria were (a) Mini-Mental State Examination (MMSE) score < 21, (b) diagnosis of dementia, (c) diagnosis of high brain dysfunction (e.g., unilateral spatial neglect and aphasia), and (d) presence of a visual field defect. The purpose of the study was explained to the subjects, and their written informed consent was obtained before the study commenced. This study was approved by the ethics committee of Ukai Rehabilitation Hospital and Reiwa Rehabilitation Hospital (approval numbers: 20210907 and 00001, respectively) and complied with the ethical standards of the 1964 Declaration of Helsinki.
Differentiating Occult Neuroretinitis and Non-Arteritic Anterior Ischaemic Optic Neuropathy: Clinical and Optical Coherence Tomography Characteristics
Published in Neuro-Ophthalmology, 2023
Snehal Ganatra, Bhavik Panchal, Avinash Pathengay, Virender Sachdeva
Automated perimetry was performed using a Humphrey Visual Field (HVF) analyser (Carl Zeiss Meditec, Inc., Dublin, Germany) at presentation using the Swedish interactive threshold algorithm (SITA)-FAST 24–2 testing strategy. Visual field data collected from the affected eye were analysed to look for the mean deviation and the pattern of any visual field defect. Both spectral domain OCT (Cirrus OCT – Carl Zeiss Meditec, Inc., Dublin, USA) and swept source OCT (Topcon – DRI OCT Triton plus, Tokyo, Japan) were used to analyse the ONH and the macula. Data were collected regarding average RNFL thickness, macular ganglion cell layer (MGCL) thickness, and central subfield thickness on spectral domain OCT. Individual line scans on spectral domain/swept source OCT were evaluated for the presence and distribution of vitreous cells, subretinal fluid (SRF), hyper-reflective dots (HRDs), and cystoid spaces between the two groups. Additional data were collected regarding the location of the cystoid spaces (peripapillary, macular, inner and outer retina). HRDs were defined as focal, punctiform discrete hyperreflective lesions within the retinal layers. OCT line scans with the most hyperreflective dots in number were taken into consideration for quantification.12 HRDs were classified on the basis of quantity (few if <10; significant if ≥10).13 Two experienced ophthalmologists (SG, BP) counted the HRDs manually.
Successful Treatment of Optic Neuropathy Associated with Sphenoid Sinus Aspergillosis
Published in Ocular Immunology and Inflammation, 2023
Sung-Dong Kim, Hyeshin Jeon, Hee-Young Choi, Kyung Un Choi
Medical treatment was initiated with amphotericin B combined with ceftriaxone and metronidazole. After the fungal culture results were positive for the Aspergillus species, amphotericin B was changed to voriconazole. After loading voriconazole 6 mg/kg q12hr IV, the maintenance dose was changed to 4 mg/kg q 12 h IV, and the oral drug was changed 5 days after administration. The visual acuity in the right was counting fingers immediately after surgery; however, it started to improve to 20/160 on the third day. One month after surgery, the last follow-up, visual acuity improved further to 20/25. Visual field examination showed improvement, but the inferior visual field defect persisted. CT of the paranasal sinuses (Figure 2b) and endoscopic examinations demonstrated no evidence of recurrence.