Dynamic topography of visual evoked potentials and extrageniculate projection in case of Riddoch phenomenon

A 34-year-old woman showing the Riddoch phenomenon was studied by the technique of dynamic topography of visual evoked potential (VEP). This case had cortical blindness which developed during the process of massive intestinal hemorrhage, shock and surgery. The visual acuity was limited to hand movement, and perception of white and colored light was present, but there was no form recognition. Tracking eye movement for a flashlight was possible and optokinetic nystagmus (OKN) also appeared. CT-scan showed a diffuse low density area in the white matter of the occipital lobe. The VEPs by flash and a checkerboard of 60'-100' were detectable. Dynamic topography of the VEP showed that a strong negative deflection from the brainstem appeared at around 30 msec and this deflection expanded to the parietal region at about 90 msec. Subsequently, a positive deflection extending from the frontal region to the occipital region continued at 100 msec to 150 msec. Such a process of reaction is not observed in the normal subject. These findings suggest that the visual reaction was conducted abnormally through the extrageniculate system; from the brainstem to the parietal area and then to the occipital area.