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[Vascular cause of hemianopsia]
H M Keller1, W E Meyer, A Valavanis
1Konsiliarius für Neuroangiologie, Hochhaus zur Schanze, Zürich.
Insights
Vascular-related hemianopsia stems from carotid or vertebrobasilar issues. Accurate diagnosis requires detailed history, examinations, and advanced imaging like CT, MRI, and ultrasound.
Area of Science:
- Neurology
- Ophthalmology
- Vascular Medicine
Background:
- Hemianopsia, a visual field defect, can arise from vascular pathologies affecting the brain's visual pathways.
- Understanding the origin is crucial for effective management and differentiating from other neurological conditions.
Observation:
- Vascular causes involve both carotid (optic tract, optic radiation) and vertebrobasilar (optic tract, striate area) systems.
- Differential diagnosis must exclude aneurysms, intracranial lesions, inflammatory, and metabolic disorders.
Findings:
- Comprehensive patient history and multi-disciplinary examinations (neurological, ophthalmological, internal medicine) are essential.
- Key diagnostic tools include neurovascular ultrasound (extracranial, transcranial Doppler), CT, MRI, and echocardiography.
Implications:
- Tailored diagnostic work-ups are necessary for each patient based on their specific presentation.
- Prompt and accurate diagnosis of vascular hemianopsia is critical for appropriate treatment and prognosis.
Abstract:
Hemianopsia of vascular origin can be caused by diseases in the carotid circulation (optic tract, proximal third of the optic radiation), as well as in the vertebrobasilar arterial system (middle and distal thirds of the optic tract, striate area/calcarina). Hemianopsia of ischemic origin must be differentiated from hemianopia in the presence of an enlarging aneurysm, a space-occupying intracranial lesion (hemorrhage, neoplasia), and inflammatory disease, occasionally in metabolic disorders. To detect the exact cause of a hemianopia in a given patient, recording of the patient's precise history and clinical-neurological, clinical-ophthalmological, and clinical-internal examinations are mandatory, as well as additional diagnostic procedures. Of these, the most important are neurovascular ultrasound examinations (extracranial, transcranial and B-mode/duplex Doppler examination), CT and MRI scans, and cardiological examination with echocardiography. The choice of these additional and costly examinations and their sequence in the diagnostic work-up in a given patient has to be adapted to the patient.