Rishi Desai, MD, MPH

Hemianopsia

First Aid 

Chapter 89 Vision Disorders  HEMIANOPSIA osms.it/hemianopsia PATHOLOGY & CAUSES ▪ Individual loses half of visual ﬁeld, commonly due to retrochiasmatic lesion of visual tract Pathogenesis ▪ Vascular ▫ Middle cerebral artery (MCA): complete contralateral hemianopia ▫ Unilateral posterior cerebral artery (PCA): contralateral hemianopia with macular sparing ▪ Mass ▫ Visual pathway compression  CAUSES  ▪ Unilateral optic tract lesion ▪ Large (complete) unilateral optic radiation lesion ▪ Quadrantanopia: sub-complete lesion, corresponds to lesioned optic radiation ▫ Upper outer-quadrant deﬁcit (“pie-inthe-sky” defect) → temporal lobe loop lesion ▫ Lower inferior quadrant deﬁcit → parietal lobe lesion ▪ Large, unilateral primary visual cortex lesion ▫ Macular visual ﬁeld spared ▪ Bilateral upper/lower visual cortex lesion → altitudinal hemianopia ▫ Upper/lower ﬁeld visual defect  COMPLICATIONS  ▪ Vascular/mass effect territory-dependent ▪ PCA distribution ▫ Diplopia, dizziness, balance issues ▪ Anterior cerebral artery (ACA)/MCA distribution ▫ Ipsilateral motor and sensory symptoms ▪ Parietal lobe involvement → contralateral neglect  ▫ Lesion to non-dominant lobe → Gerstmann syndrome (ﬁnger agnosia, acalculia, agraphia, right-left visualization) ▪ Temporal lobe involvement → seizure  SIGNS & SYMPTOMS ▪ Visual ﬁeld loss ▫ Unilateral hemianopia: contralateral optic tract lesion (homonymous hemianopia); large, contralateral optic radiation lesion ▫ Superior quadrantanopia: contralateral temporal lobe lesion of optic radiation loop ▫ Inferior quadrantanopia: contralateral parietal lobe lesion of optic radiation loop ▪ Neurologic examination ▫ CN II testing: visual ﬁeld ▫ Motor/sensory testing for concomitant symptoms  DIAGNOSIS ▪ History, physical examination  DIAGNOSTIC IMAGING MRI ▪ Mass lesions/old stroke (preferred method) CT scan ▪ Mass lesion and acute, hemorrhagic stroke  TREATMENT SURGERY  ▪ Resection: mass compressing the visual pathway  OSMOSIS.ORG 687   

Anatomy of the cranial base

Anatomy of the external and middle ear

Anatomy of the eye

Anatomy of the infratemporal fossa

Anatomy of the inner ear

Anatomy of the nose and paranasal sinuses

Anatomy of the oral cavity

Anatomy of the orbit

Anatomy of the pterygopalatine (sphenopalatine) fossa

Anatomy of the salivary glands

Anatomy of the temporomandibular joint and muscles of mastication

Anatomy of the tongue

Bones of the cranium

Muscles of the face and scalp

Nerves and vessels of the face and scalp

Anatomy clinical correlates: Ear

Anatomy clinical correlates: Eye

Anatomy clinical correlates: Skull, face and scalp

Anatomy clinical correlates: Temporal regions, oral cavity and nose

Head

Anatomy of the larynx and trachea

Anatomy of the lymphatics of the neck

Anatomy of the pharynx and esophagus

Anatomy of the thyroid and parathyroid glands

Bones of the neck

Deep structures of the neck: Prevertebral muscles

Deep structures of the neck: Root of the neck

Fascia and spaces of the neck

Superficial structures of the neck: Anterior triangle

Superficial structures of the neck: Cervical plexus

Superficial structures of the neck: Posterior triangle

Anatomy clinical correlates: Bones, fascia and muscles of the neck

Anatomy clinical correlates: Vessels, nerves and lymphatics of the neck

Anatomy clinical correlates: Viscera of the neck

Neck

Introduction to the cranial nerves

Cranial nerve pathways

Anatomy of the olfactory (CN I) and optic (CN II) nerves

Anatomy of the oculomotor (CN III), trochlear (CN IV) and abducens (CN VI) nerves

Anatomy of the trigeminal nerve (CN V)

Anatomy of the facial nerve (CN VII)

Anatomy of the vestibulocochlear nerve (CN VIII)

Anatomy of the glossopharyngeal nerve (CN IX)

Anatomy of the vagus nerve (CN X)

Anatomy of the spinal accessory (CN XI) and hypoglossal (CN XII) nerves

Anatomy clinical correlates: Olfactory (CN I) and optic (CN II) nerves

Anatomy clinical correlates: Oculomotor (CN III), trochlear (CN IV) and abducens (CN VI) nerves

Anatomy clinical correlates: Trigeminal nerve (CN V)

Anatomy clinical correlates: Facial (CN VII) and vestibulocochlear (CN VIII) nerves

Anatomy clinical correlates: Glossopharyngeal (CN IX), vagus (X), spinal accessory (CN XI) and hypoglossal (CN XII) nerves

Cranial nerves

Anatomy

Development of the ear

Development of the eye

Development of the face and palate

Pharyngeal arches, pouches, and clefts

Embryology

Eye and ear histology

Nasal cavity and larynx histology

Thyroid and parathyroid gland histology

Histology

Conductive hearing loss

Eustachian tube dysfunction

Otitis externa

Otitis media

Tympanic membrane perforation

Ear disorders

Age-related macular degeneration

Bitemporal hemianopsia

Cataract

Color blindness

Cortical blindness

Diabetic retinopathy

Glaucoma

Homonymous hemianopsia

Retinal detachment

Neonatal conjunctivitis

Retinoblastoma

Retinopathy of prematurity

Corneal ulcer

Periorbital cellulitis

Uveitis

Keratitis

Orbital cellulitis

Hordeolum (stye)

Conjunctivitis

Eye disorders

Bacterial epiglottitis

Laryngitis

Laryngomalacia

Laryngeal disorders

Allergic rhinitis

Choanal atresia

Nasal polyps

Nasopharyngeal carcinoma

Nasal and nasopharyngeal disorders

Aphthous ulcers

Ludwig angina

Oral cancer

Oral candidiasis

Parotitis

Sialadenitis

Temporomandibular joint dysfunction

Warthin tumor

Esophageal cancer

Gastroesophageal reflux disease (GERD)

Retropharyngeal and peritonsillar abscesses

Sleep apnea

Zenker diverticulum

Oral cavity and oropharyngeal disorders

Thyroglossal duct cyst

Thyroid cancer

Hyperparathyroidism

Hypoparathyroidism

Thyroid and parathyroid gland disorders

Acoustic neuroma (schwannoma)

Labyrinthitis

Meniere disease

Vertigo

Vestibular disorders

Eye conditions: Inflammation, infections and trauma: Pathology review

Eye conditions: Refractive errors, lens disorders and glaucoma: Pathology review

Hemianopsia

Videos

Notes

Hemianopsia

Ear disorders

Eye disorders

Laryngeal disorders

Nasal and nasopharyngeal disorders

Oral cavity and oropharyngeal disorders

Thyroid and parathyroid gland disorders

Vestibular disorders

Eyes, ears, nose, and throat pathology review

Assessments

Flashcards

High Yield Notes

Flashcards

Hemianopsia

External References

First Aid

Hemianopia p. 530, 562

Hemianopia with macular sparing p. 562

Quadrantic hemianopia

Summary

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