Homonymous hemianopia

Specialty: Neurology.

• loss of half of the contralateral visual field
• one hemifield blindness

Why it occurs

• Ischemic or hemorrhagic stroke affecting the optic radiations (temporal or parietal lobe) or the primary visual cortex in the occipital lobe (posterior cerebral artery)
• Primitive or metastatic brain tumors of the occipital or temporal lobe with mass effect
• Head trauma with unilateral occipital hemorrhagic contusion
• Abscess or parasitic cyst (cysticercosis) in the postchiasmatic visual pathway
• Extensive demyelinating plaque in optical radiations

Initial workup

Humphrey or Goldmann formal visual computerized campimetry to precisely delineate the field defect (congruent or incongruent homonymous hemianopia, with or without macular sparing); Brain MRI (or urgent brain CT if there is suspicion of acute bleeding) focused on the posterior course of the optic pathway.

Standard management

• Antithrombotic treatment (acetylsalicylic acid 100-300 mg/day or Clopidogrel 75 mg/day) or anticoagulant according to the etiology of the stroke
• Dexamethasone or mannitol if associated with severe peritumoral edema that compromises the posterior visual pathway.