Visual fields, by Nancy Newman

 

Horizontal respect

in retinal ganglion cells, respect horizontal raphe, send bundles into optic nerve in that fashion

 

If no respect for vertical, have to be in front of the chiasm

 

Central scotoma, within 20 degrees

Centrocecal, central and blind spot

Paracentral, outside of 20 degrees

Arcuate

 

Bjerrum scotoma - glc, optic neuritis

altitudinal defect - glc, ischemic neuropathy, branch artery occulision, hydroplastic nerve

central scotomas - optic neuritis, maculopathy

centrocecaldefects - toxic and deficiency neuropathies

nasal defects - glc, chronic papilledema, drusen

 

altitudinal - defects confined to the upper or lower half of the field

homonymous - defects in the fields of both eeyes and on the same side of midline

congruous - homonymous defects identical in the two eyes

 

retrochiasmal lesions are homonymous

tract: non-congruous if partial; optic atrophy

geniculate: non-congruous;optic atrophy

temporal: non-congrous, superior

parietal: congruous, inferior

occipital: congruous, may spare fixation, may be scotomatous; temporal crescent

the more posterior, the more congruous

 

1 eye or 2?

does it respect the vertical?

is it homonomous?  if not, likely at chiasm

 

parietal is superior

temporal is inferior

 

most central portion of visual field is most posterior portion of occipital cortex

 

middle cerebral supply to occipital lobe - feeds medial portion of that lobe

if infarct PCA, can have macular sparing because it is supplied by MCA

 

occipital lobe - temporal crescent, congruous homonymous scotomas, complete hemianopia with sparing of fixation

 

lateral geniculate - homonymous "innie" defect (posterior choroidal artery) and  "outie" (defect anterior choroidal artery)

 

if no respect for horizontal, can be RP, glc, or constricting papilledema (but should have nasal step) - retinal degenerations

 

respects horizontal and vertical, congruous, is occipital lobe infarct

 

temporal crescent sparing - spare most anterior portion of calcuran cortex

 

if complete congruous homonymous anopsia, cannot say more than behind chiasm on one side

 

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