[Hypertensive basal ganglionic hemorrhage with hemianopsia as the sole symptom--report of 2 cases]

The majority of patients with sudden onset of homonymous hemianopia are caused by occlusion of the posterior cerebral artery. Apart from a subcortical hemorrhage in the occipital lobe, no previous cases of the hypertensive intracerebral hemorrhage presenting isolated homonymous hemianopia have been reported. Since the introduction of computed tomography (CT), the authors have experienced two cases of hypertensive basal ganglionic hemorrhage (including a thalamic hemorrhage) showing homonymous hemianopia alone as the neurological manifestation. Both patients (age 40 and 45) are right-handed male with known hypertension. The CT scans demonstrated a hematoma laterally and posteriorly along the thalamus on the left side. The cerebral angiography were unremarkable. The authors discussed the mechanism presenting homonymous hemianopia without association of pyramidal signs. These two cases described above are unique, hypertensive basal ganglionic hemorrhage, presenting a localized damage in the optic peduncle with sparing the pyramidal tract. In addition, they are worthwhile to be paid attention, because of showing homonymous hemianopia as a single, neurological manifestation, as well as being able to be diagnosed only by CT.