Impairment Of Vision

CLINICAL APPROACH AND DIFFERENTIAL DIAGNOSIS (,contd) Congruous homonymous hemianopia (fields can be exactly superimposed)

Inferior quadrantanopia

Inferior quadrantanopia

At the temporo-parietal junction where fibres meet, lesions produce a complete 'homonymous hemianopia'.

Homonymous hemianopia ivith macular involvement

Homonymous hemianopia ivith macular involvement

Right occipital lobe (medial aspect)

Complete visual loss

Pupil response spared

Right occipital lobe (medial aspect)

Calca rine fissure

BILATERAL VISUAL CORTEX DAMAGE -

Calca rine fissure

Right calcarine---

cortex indicate lesion involving the POLE OF THE CALCARINE CORTEX \

j tumour - usually intrinsic ! i.e. glioma or metastasis

i CT scan/MRI

' In vascular disease the macula is often spared, perhaps as a result of the dual blood supply (posterior and middle cerebral arteries) in this area.

BILATERAL VISUAL CORTEX DAMAGE -

'cortical blindness' with or without awareness.

usually a vascular cause, e.g. basilar artery occlusion

The interpretation of the visual image and its integration with other cortical functions is discussed under 'Higher cortical function'.

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