Journal of The Korean Ophthalmological Society (대한안과학회지)

The Korean Ophthalmological Society (대한안과학회)
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A Case of Functional Bitemporal Hemianopia Respecting the Vertical Meridian

수직경선을 가로지르는 양안 기능성 이측반맹 1예

Han, Sang-Beom;Hwang, Jeong-Min
한상범;황정민

  • Published : 2009.06.15
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Abstract

Purpose: To report a case of functional bilateral hemianopia which was not associated with any organic causes. Case Summary: A 35-year-old female patient presented with bilateral disturbance of visual acuity and visual field, which had begun 8 months prior. Goldmann perimetry showed bitemporal hemianopsia respecting the vertical meridian. Pupillary response was normal, and the anterior segment, fundus, and optic nerve were also normal bilaterally. However, the tangent screen test and Humphrey visual field test showed a widening of hemianopia not respecting the vertical meridian, and the crossing of isopters at 1 m and 2 m with the tangent screen test. In addition, multifocal electroretinogram and multifocal visual evoked potential did not reveal any abnormal findings corresponding to the bitemporal hemianopia. Brain magnetic resonance imaging showed no abnormal findings in the orbit and brain. Conclusions: Bitemporal hemianopsia can be developed functionally, although it may be rare. Repetition of various visual field tests and use of multifocal electrophysiologic studies can be helpful in the differential diagnosis.

목적: 기질적인 원인이 없이 발생한 양안의 이측반맹 1예를 보고하고자 한다. 증례요약: 35세 여자환자가 8개월 전부터 시작된 양안의 시력저하 및 시야장애를 주소로 의뢰되었다. 골드만시야검사에서 양안에 수직경선을 따르는 이측반맹을 보였다. 양안 모두 동공반응은 정상이었으며, 전안부, 시신경 및 망막도 모두 정상이었다. 험프리시야검사와 탄젠트스크린검사에서는 시야가 반맹보다 넓어졌고 수직경선을 따르지 않았으며, 특히 1미터와 2미터에서의 탄젠트스크린검사 상시야가 서로 교차하는 소견을 보였다. 다초점망막전위도검사와 다초점시유발전위검사에서 시야 이상에 합당한 소견이 없었고, 뇌자기공명영상 역시 정상이어서 기능성으로 진단하였다. 결론: 양안의 이측반맹이 드물게 기능성으로 발생할 수 있으며, 다른 종류의 시야검사를 반복하는 것과 다초점전기생리검사가 감별진단에 도움이 될 수 있다.

Keywords

References

  1. Palmowski AM, Fischer A, Ruprecht KW. Multifocal examination techniques in malingering: case report of a patient with monocular vertical hemianopia. Graefes Arch Clin Exp Ophthalmol 2003; 241:70-1 https://doi.org/10.1007/s00417-002-0594-4
  2. Hershenfeld SA, Sharpe JA. Monocular temporal hemianopia. Br J Ophthalmol 1993;77:424-7 https://doi.org/10.1136/bjo.77.7.424
  3. Bakker SL, Hasan D, Bijvoet HW. Compression of the visual pathway by anterior cerebral artery aneurysm. Acta Neurol Scand 1999;99:204-7 https://doi.org/10.1111/j.1600-0404.1999.tb07347.x
  4. Hilton GF, Hoyt WF. An arteriosclerotic chiasmal syndrome. Bitemporal hemianopia associated with fusiform dilatation of the anterior cerebral arteries. JAMA 1966;196:1018-20 https://doi.org/10.1001/jama.196.11.1018
  5. Shikishima K, Kitahara K, Mizobuchi T, Yoshida M. Interpretation of visual field defects respecting the vertical meridian and not related to distinct chiasmal or postchiasmal lesions. J Clin Neurosci 2006;13:923-8 https://doi.org/10.1016/j.jocn.2005.11.047
  6. Smith TJ, Baker RS. Perimetric findings in functional disorders using automated techniques. Ophthalmology 1987;94:1562-6
  7. Ohkubo H. Visual field in hysteria-reliability of visual field by Goldmann perimetry. Doc Ophthalmol 1989;71:61-7 https://doi.org/10.1007/BF00155133
  8. Thompson JC, Kosmorsky GS, Ellis BD. Field of dreamers and dreamed-up fields: functional and fake perimetry. Ophthalmology 1996;103:117-25
  9. Kim SY, Lee DH, Park SH. An analysis of visual fields in patients with post-traumatic functional visual loss. J Korean Ophthalmol Soc 2004;45:469-79
  10. Keltner JL, Johnson CA, Spurr JO, Beck RW. Baseline visual field profile of optic neuritis. The experience of the optic neuritis treatment trial. Optic Neuritis Study Group. Arch Ophthalmol 1993;111231-4 https://doi.org/10.1001/archopht.1993.01090020085029
  11. Gittinger JW, Jr. Functional monocular temporal hemianopsia. Am J Ophthalmol 1986;101:226-31
  12. Savino PJ, Glaser JS, Schatz NJ. Traumatic chiasmal syndrome. Neurology 1980;30:963-70 https://doi.org/10.1212/WNL.30.9.963
  13. Johnson LN, Rabinowitz YS, Hepler RS. Hemianopia respecting the vertical meridian and with foveal sparing from retinal degeneration. Neurology 1989;39:872-3 https://doi.org/10.1212/WNL.39.6.872
  14. Miele DL, Odel JG, Behrens MM, et al. Functional bitemporal quadrantopia and the multifocal visual evoked potential. J Neuroophthalmol 2000;20:159-62 https://doi.org/10.1097/00041327-200020030-00004
  15. Massicotte EC, Semela L, Hedges TR, 3rd. Multifocal visual evoked potential in nonorganic visual field loss. Arch Ophthalmol 2005;123:364-7 https://doi.org/10.1001/archopht.123.3.364
  16. Goldberg I, Graham SL, Klistorner AI. Multifocal objective perimetry in the detection of glaucomatous field loss. Am J Ophthalmol 2002;133:29-39 https://doi.org/10.1016/S0002-9394(01)01294-6
  17. Maccolini E, Andreoli A, Valde G, et al. Hemifield patternreversal visual evoked potentials (VEPs) in retrochiasmal lesions with homonymous visual field defect. Ital J Neurol Sci 1986; 7:437-42 https://doi.org/10.1007/BF02283022
  18. Woung LC, Jou JR, Liaw SL. Visual function in recovered ethambutol optic neuropathy. J Ocul Pharmacol Ther 1995;11: 411-9