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Homonymous field defect as the first manifestation of Creutzfeldt-Jakob disease
M E Vargas1, M J Kupersmith, P J Savino
1Department of Ophthalmology, New York University Medical Center, New York, USA.
Purpose:
Although in the early stage of Creutzfeldt-Jakob disease most patients have obvious dementia, we found that the disease can be diagnosed in patients solely on the basis of a visual system disorder.
Methods:
We examined three patients who initially complained of a nonspecific, insidious visual disturbance.
Results:
The three patients were found to have Creutzfeldt-Jakob disease, confirmed by histopathologic analysis. Each patient had a homonymous hemianopsia on the first neuro-ophthalmologic examination. The initial neurologic, neuroimaging, and electrophysiologic examinations were not conclusive. The subsequent rapid deterioration in the neurologic status, including dementia and typical electroencephalographic changes, was suggestive of Creutzfeldt-Jakob disease.
Conclusion:
At onset of Creutzfeldt-Jakob disease, patients may have a homonymous hemianopsia despite normal results of magnetic resonance imaging of the brain and neurologic examination.