Ординатура / Офтальмология / Английские материалы / Ocular Differential Diagnosis 7th edition_Roy_2002

Louis: CV Mosby, 1990.

Unilateral Sector-Shaped Defects

In this condition, the narrow end of scotoma characteristically touches the physiologic blind spot.

1. Optic disc involvement

A.Glaucoma (early stages primarily on nasal side)

B.Papillitis

C.Secondary optic atrophy after choked disc (more on nasal side)

2. Retina

A.Branch artery occlusion (see p. 468â??472)

B.Juxtapapillary chorioretinitis

3. Optic nerveâ??between disc and chiasm

A.Aneurysm

B.Drusen

C.Tumor

Hart WM, Becker B. The onset and evolution of glaucomatous visual field defects. Ophthalmology 1982;89:268.Bibliographic Links

Spekreijse H, Apkarian PA. Visual pathways. The Hague, Netherlands: Dr. Junk, 1981.

Peripheral-Field Contraction

Central vision is present; the patient may complain of poor night vision.

1. Choroiditisâ??periphery of fundus

2. *Chronic atrophic papilledema (pseudotumor cerebri)

3. Bilateral homonymous hemianopia (if the macular sparing in one homonymous hemiapnopia

P.609

is larger than that in the other homonymous hemianopia, the spared central portion of the field has small vertical steps, above and below fixation, where the two areas of macular sparing do not quite coincide.)

A.Cortical blindness with damage to occipital lobe and macular recovery 1. Anoxia

2. Carbon monoxide poisoning

3. Cardiac arrest

4. Cerebral angiography

5. Exsanguination

6. Trauma

B. Stroke of infarction of occipital lobe

Louis: CV Mosby, 1990.

Kokame GT. Visual field defects after vitrectomy with fluid-air exchange. Am J Ophthalmol 2000;129:653â??654.Bibliographic Links

Altitudinal Hemianopia

This condition comprises defective vision or blindness in the upper or lower horizontal half of the visual field. It may be unilateral or bilateral; unilateral field defect is prechiasmal.

1. Anemiaâ??produces bilateral inferior altitudinal hemianopia

2. *Anterior ischemic optic neuropathy

3. Bilateral branch retinal artery occlusion

4. Fusiform aneurysms (arteriosclerotic or congenital)â??may produce inferior altitudinal hemianopia by pressure against the lateral halves of the optic chiasm or nerve

5. Herpes zoster

6. Lesion that presses the chiasm upward against the superior margin of the optic foramen 7. Occipital lobe lesions

A.Hypoxia

B.Stroke

8. Olfactory groove meningioma extending posteroinferior to compress the intracranial portion of the optic nerve

9. Optic-nerve lesion

A.Anterior ischemia optic neuropathy

B.Coloboma

C.Glaucoma

D.Optic neuritis

E.Papilledema

F.*Trauma

G.Tumor

10. Sclerotic plaques of internal carotid artery or anterior cerebral arteriesâ??pressure of plaques on optic nerve results in inferior altitudinal hemianopia

11. Following pars plana vitrectomy

Harrington DO, Drake MV. The visual fields: a text and atlas of clinical perimetry, 6th ed. St. Louis: CV Mosby, 1990.

Miyashita K, et al. Superior altitudinal hemianopia and herpes zoster. Ann Ophthalmol 1993;25:20â??23.Bibliographic Links

Binasal Hemianopia

This condition comprises defects in the nasal half of visual fields, usually incomplete. This condition is due to lateral involvement of chiasm; it presupposes bilateral lesions.

P.611

1. Bilateral occipital lesion (thrombosis)

2. Chiasmic arachnoiditis, postneuritic optic atrophy, and bilateral retrobulbar neuritis of multiple sclerosis

3. Damage to chiasm

4. Drusen of optic nerve (see p. 559)

5. Fusiform aneurysmsâ??arteriosclerotic or congenitalâ??of internal carotid artery

6. Glaucoma

7. Meningiomas, especially from the lesser wing of the sphenoid bone

8. Nasal quadrant peripheral depression of glaucomaâ??bilateral and reasonably symmetrical 9. Pituitary tumor with third ventricle dilatation pushing laterally

10. Retinal damage

11. Severe exsanguination

12. Sclerotic plaques of internal carotid artery or anterior cerebral arteries

13. Symmetric lesions in the temporal halves of both retinas, such as severe retinal edema associated with diabetic retinopathy

14. Trauma

Cox TA, et al. Unilateral nasal hemianopia as a sign of intracranial optic nerve compression. Am J Ophthalmol 1981;92:230â??232.Bibliographic Links

Harrington DO, Drake MV. The visual fields: text and atlas of clinical perimetry, 6th ed. St. Louis: CV Mosby, 1990.

Pau H. Differential diagnosis of eye diseases, 2nd ed. New York: Thieme Medical, 1988.

Bitemporal Hemianopia

This condition involves defects in the temporal half of the visual field, usually incomplete; it is due to pressure on the optic chiasm.

1. Chiasmal lesions

A.Congenital defect such as de Morsier syndrome (septooptic dysplasia); autosomal dominant

B.Inflammatory lesions

1. *Basal meningitis, including: chronic chiasmal syphilitic, tuberculous, actinomycotic, and cysticercal arachnoiditis

2. Chiasmal neuritis

C.Tumors of the chiasm

1. *Primary tumors, including gliomas in childhood

2. *Secondary tumors (rare), including meningiomas, retinoblastoma, pinealoma, and ependymoma

D.Vascular lesions

1. Arterial compression

2. Arteriosclerosis

3. Ectasia of the intracranial carotid arteries

4. *Intracranial aneurysms, such as congenital, endocardial emboli, traumatic, atheromatous, or syphilitic, especially intrasellar aneurysms

5. Thrombosis of the carotid artery

2. Perisellar lesions

A. Parasellar tumors

1. Injuries to the chiasmal pathway, such as from trauma 2. *Meningioma of the sphenoid ridge

P.612

3. Migraine

4. Sudden onset without apparent cause

a.Arteriosclerotic or giant cell arteritic occlusion of nutrient vessels of the chiasm in older patients

b.Disseminated sclerosis

5. Tumors of the basal meninges

6. Tumors of the sphenoid bone including osteochondroma, sarcoma, anaplastic carcinoma

B.Presellar tumors

1. *Meningioma of the olfactory groove

2. Neuroblastoma of the olfactory groove

C.Suprasellar tumors

1. Chordoma

2. *Craniopharyngiomaâ??manifestations may include diabetes insipidus, infantilism, and calcification of hypophyseal-pituitary region

3. Epidermoids

4. Lymphoblastoma

5. Pinealoma

6. *Suprasellar meningioma

7. Teratoma

homonymous hemianopsia. Am J Ophthalmol 1991;111:413â??418.Bibliographic Links

Harrington DO, Drake MV. The visual fields: textbook and atlas of clinical perimetry, 6th ed. St. Louis: CV Mosby, 1990.

Crossed Quadrantanopia

In this condition, the upper quadrant of one visual field is along with the lower quadrant of opposite visual field.

1. *Asymmetric homonymous hemianopia, such as vascular lesion of the upper lip of the calcarine area on one side and the lower lip of the opposite calcarine cortex

2. Chiasm compression from lesion below compressing it against contiguous arterial structure 3. Glaucoma

4. Inflammatory lesion, such as choroiditis juxtapapillaris

Harrington DO, Drake MV. The visual fields: text and atlas of clinical perimetry, 6th ed. St. Louis: CV Mosby, 1990.

Homonymous Hemianopia

This type of hemianopia affects the right or left halves of the visual fields; the lesion is posterior to the optic chiasm,

1. Optic tract lesionsâ??visual conduction system posterior to optic chiasm and anterior to lateral geniculate body; lesion demonstrates incongruous field defect on side opposite to defect, often with decreased vision, optic atrophy and afferent pupil.

A.Demyelinative diseaseâ??retrobulbar, multiple sclerosis, and Schilder disease

B.Migraine

C.Pituitary adenomas and craniopharyngiomas (most common); nasopharyngeal carcinomas, chordomas, infundibulomas, and gliomas (less common)

D.Saccular aneurysms of internal carotid or posterior communicating artery

E.Trauma

2. Temporoparietal lesionsâ??temporal lobe lesions are manifest initially in the upper visual fields, whereas lesions of the parietal lobe are first manifest in the lower visual fields

A.Diffuse demyelinative diseases

1. Krabbe type (Sturgeâ??Weberâ??Krabbe syndrome)

2. Metachromatic leukoencephalopathy

3. Pelizaeusâ??Merzbacher type (aplasia axialis extracorticalis congenita)

4. Progressive multifocal leukoencephalopathy

5. Schilder type (encephalitis periaxialis diffusa)

6. Spongy degeneration of the brain (Canavan disease)

B.Migraine

C.Tumorâ??gradual onset of symptomsâ??lesions include intrinsic astrocytoma and glioblastoma, extrinsic meningioma, and lung metastasis

D.Vascular lesionsâ??sudden onset

1. Embolismâ??may be associated with rheumatic or arteriosclerotic heart disease, bacterial endocarditis, myocardial infarction, or septic focus in lungs

P.614

2. Occlusionâ??middle cerebral occlusion affects primarily the arm and face; anterior cerebral occlusion affects primarily the leg

3. Subdural hematomaâ??spontaneous or following trauma

4. Thrombosisâ??premonitory symptoms include unilateral blackouts in one eye

E. Trauma (surgical)

3. Occipital lesionsâ??congruous field defect and macular sparing most likely

A.Demyelinative disease

1. Creutzfeldtâ??Jakob disease

2. Krabbe type (Sturgeâ??Weberâ??Krabbe syndrome)

3. Metachromatic leukoencephalopathy

4. Pelizaeusâ??Merzbacher type (aplasia axialis extracorticalis congenita)

5. Progressive multifocal leukoencephalopathy

6. Schilder type (encephalitis periaxialis diffusa)

7. Spongy degeneration of the brain (Canavan disease)

B.Migraine

C.Poisons, such as carbon monoxide, digitalis, mescal, opium, lysergic acid diethylamide

D.Trauma

1. Directâ??penetrating missiles and depressed bone fragments

2. Indirectâ??general concussion syndrome

3. Temporal lobectomy

E.Tumorsâ??gradual onset of symptomsâ??lesions include intrinsic astrocytoma and glioblastoma, extrinsic meningioma, and lung metastasis

F.Vascular lesionâ??sudden onset

1. Arteriovenous anomalies

2. Aneurysms (rare)

3. Occlusion of posterior cerebral arteryâ??thrombotic or embolic

4. Subclavian steal syndrome, with reversal of blood flow through the vertebral artery

Harrington DO, Drake MV. The visual fields: text and atlas of clinical perimetry, 6th ed. St. Louis: CV Mosby, 1990.