Homonymous Hemianopia

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Homonymous Hemianopia

• bilateral loss of same half of visual field in each eye
• lesion posterior to optic chiasm

Examination

• General
  • ipsilateral hemiparesis
• Acuity
  • normal
• Fields
  • optic tract lesion
    • may be asymmetrical
  • optic radiation
    • upper quadrants 
      • temporal lobe disease
    • lower quadrants
      • parietal lobe disease
  • occipital cortex
    • macular sparing
• Pupils 
  • normal
• Movements
  • normal
• Fundi
  • normal
• "I would like to..."
  • focal neurology
  • neglect
  • dysphasia

Investigation

• formal perimetry testing
• CT brain scan
• risk factors for CVA
  • Hypertension
  • Atrial Fibrillation
  • Diabetes Mellitus
  • Carotid Bruits

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