Congruous and incongruous sectoral visual field defects with lesions of the lateral geniculate nucleus

Quantitative perimetric studies in two women, each 52 years of age, with involvement of the lateral geniculate nucleus (caused by a small arteriovenous malformation in one and by an astrocytoma in the other) disclosed a striking wedge-shaped horizontal sectoranopia that was perfectly congruous in one case and incongruous in the other. Selective interruption of the dual blood supply to the lateral geniculate nucleus (with the anterior choroidal artery supplying the anterior hilus, together with the anterior and lateral nucleus and the lateral choroidal artery supplying the remainder of the nucleus) may result in a congruous visual field defect with steeply sloping borders because such a lesion must respect the anatomic boundaries produced by this vascular supply. Partial infiltration or involvement of the lateral geniculate nucleus (where uncrossed retinal projections terminate in one group of laminae, while crossed retinal projections terminate in another) provides a logical explanation for the occurrence of incongruous visual field defects. This unusual horizontal wedge-shaped defect should suggest lateral geniculate nucleus involvement, especially in the absence of trauma.