Peripheral homonymous hemianopia: correlation between lesion location and visual field defects by means of...

Peripheral homonymous scotomas beyond 30° from fixation are rare. The paucity of publications describing such visual field defects might be attributed to various factors, including the absence of severe symptoms, routine visual field assessment restricted to the central 30° with automated perimetry, and the collateral circulation to the occipital cortex. The aim of this study was to correlate the brain lesions and perimetric findings in 2 unusual cases of peripheral homonymous scotomas, with the anatomic location of the optic radiation and primary visual cortex.

Two patients with circumscribed homonymous scotomas beyond 30° related to infarcts in the intermediate area of the visual cortex are reported. We describe a new strategy, which relies on modern lesion analysis and stereotaxic probabilistic cytoarchitectonic maps, to accurately correlate the brain lesion site with the location of the peripheral homonymous visual field defects.

In Case 1, the posterior optic radiation was affected in its termination in the upper intermediate visual cortex. In Case 2, the lesion was located in the upper rostral portion of the primary visual cortex. In both, the most anterior part of the visual cortex and the occipital pole were intact, accounting for preservation of the central and most peripheral visual field. Additionally, correlation of the neuroimaging findings with commonly used maps of the representation of the visual field on the striate cortex suggested that our data were most consistent with the Holmes map.

Modern lesion analysis and cytoarchitectonic maps, in combination with the existing retinotopic maps, may provide reliable clues for the localization of cerebral infarction and prognosis of homonymous visual field defects and may lead to a better understanding of the link between neuroanatomical landmarks and functional outcomes.