100 Chapter 6: Failure of pattern recognition
A
B
Figure 6.11 Example of a quadruple sectoranopia due to right anterior choroidal artery occlusion. (A) There is homonymous field loss involving the upper and lower quadrants but sparing central fibers. (B) Axial FLAIR MR image demonstrates the corresponding right LGB stroke (arrow).
radiations rather than the LGB, either of these patterns carries great localizing value and can thus be extremely helpful clinically, as illustrated in the above case. This is another example in which the clinical findings are the key to interpreting the radiographic study. Without the information from the visual field, the responsible lesion is lost in the background noise of scattered small vessel disease.
Diagnosis: Lateral geniculate body stroke
Tip: The exquisite localizing value of this particular visual field pattern enables the clinician to dis-
tinguish the causative lesion from other, clinically insignificant, areas of ischemic white matter disease.
FURTHER READING
Painful ophthalmoplegia
International Headache Society, The international classification of headache disorders ICHD-II. Cephalalgia, 24 Suppl. 1 (2004), 131.
L.B. Kline, W. F. Hoyt, The Tolosa-Hunt syndrome. J Neurol Neurosurg Psychiatry, 71 (2001), 577–82.
D. M. Yousem, S. W. Atlas, R. Grossman et al., MR imaging of Tolosa-Hunt syndrome. AJNR, 10 (1990), 1181–4.
Orbital apex syndrome
A. Ettl, K. Zwrtek, A. Daxer, E. Salomonowitz, Anatomy of the orbital apex and cavernous sinus on highresolution magnetic resonance images. Surv Ophthalmol, 44 (2000), 303–23.
E.B. Ing, V. Purvin, Progressive visual loss and motility deficit. Surv Ophthalmol, 41 (1997), 488–92.
Third nerve misdirection
N. J. Schatz, P. J. Savino, J. J. Corbett, Primary aberrant oculomotor regeneration. Arch Neurol, 34 (1977), 29–32.
P.A. Sibony, C. Evinger, S. Lessell, Retrograde horseradish peroxidase transport after oculomotor nerve injury.
Invest Ophthalmol Vis Sci, 27 (1986), 975–80.
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P.A. Sibony, S. Lessell, J. W. Gittinger, Acquired oculomotor synkinesis. Surv Ophthalmol, 28 (1984), 382–90.
Lateral geniculate body
L.Frisen, Quadruple sectoranopia and sectoral optic atrophy: a syndrome of the distal anterior choroidal artery. J Neurol Neurosurg Psychiatry, 42 (1979), 590–4.
L. Frisen, L. Holmegaard, M. Rosencrantz, Sectorial optic atrophy and homonymous, horizontal sectoranopia: a lateral choroidal artery syndrome? J Neurol Neurosurg Psychiatry, 41 (1978), 374–80.
J.C. Horton, K. Landau, P. Maeder, W. F. Hoyt, Magnetic resonance imaging of the human lateral geniculate body. Arch Neurol, 47 (1990), 1201–6.