Can visual function be restored in patients with homonymous hemianopia?

Pambakian, A L M; Kennard, Christopher

doi:10.1136/bjo.81.4.324

Cited by 116 publications

(110 citation statements)

References 41 publications

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“…Similar differences in age and history of diabetes were noticed by others in a series of patients with various etiologies of homonymous hemianopia and, in case of vascular origin, of nonthrombolysed patients. 13 Our data suggest that etiology of cardioembolism favors better outcome, which was supported by nonsignificantly more frequent history of atrial fibrillation and less common use of antiplatelet agents in patients who improved. However, a small number of patients do not allow us to make any firm conclusion on this subject.…”

Section: Discussionsupporting

confidence: 53%

“…15 Better improvement (33%-38%) was noticed in other studies; 3 however, proportion of vascular origin was lower (73%-68%), reflecting the worst prognosis of spontaneous recovery of homonymous hemianopia of vascular origin. 13 However, as many as 46% and 67% of hemianopes of vascular origin (both ischemic and hemorrhagic stroke) in the occipital lobe improved in a series of 69 and 99 patients. 4,16 None of the aforementioned studies included thrombolysis-treated patients.…”

Section: Discussionmentioning

confidence: 99%

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Intravenous Thrombolysis in Ischemic Stroke Patients With Isolated Homonymous Hemianopia

Strbian

Ahmed

Wahlgren

et al. 2012

Stroke

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on behalf of SITS InvestigatorsBackground and Purpose-Hemianopia can cause considerable disability. Only scarce data are available for ischemic stroke patients presenting with isolated homonymous hemianopia and being treated with intravenous thrombolysis. We analyzed outcome of such patients registered in the Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register (SITS-ISTR). Methods-The SITS-ISTR (nϭ45 079) was searched for patients who presented with isolated homonymous hemianopia.We identified 72 such patients. We report their baseline and demographic characteristics, radiological data, change in their National Institutes of Health Stroke Scale score within 7 days after thrombolysis, and their 3-month modified Rankin Scale (mRS) score. Univariate analysis of parameters associated with any improvement was performed. Hemianopia was assessed with perimetric examination. Results-Of 72 patients, 40 (56%) improved within 7 days after thrombolysis; 19 (26%) had full recovery. Those who improved had significantly lower systolic blood pressure before thrombolysis and were less often administered antiplatelet agents before index stroke. Infarction was visible on 24-hour computed tomography scan in 65% of patients who improved compared with 81.2% of those without improvement (Pϭ0.32). No symptomatic intracranial hemorrhage occurred in patients who improved compared with 1 (3.1%) patient in the nonimproved group (Pϭ0.08). Seventy-one percent of all patients had 3-month mRS score 0 to 2, and 51% had mRS score 0 to 1. Those who improved within 7 days had a significantly better 3-month outcome (median mRS [interquartile range], 0 [0 -1] vs 2 [1-2]). Conclusions-Relatively few ischemic stroke patients received thrombolysis because of isolated homonymous hemianopia. Thrombolysis seems to be safe in these patients. Of those treated, more than half improved and more than two-thirds had good outcome. (Stroke. 2012;43:2695-2698.)

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Intravenous Thrombolysis in Ischemic Stroke Patients With Isolated Homonymous Hemianopia

Strbian

Ahmed

Wahlgren

et al. 2012

Stroke

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“…27 However, the locations of all visual deficits in our study were relatively consistent across the lobes (30% occipital, 32% parietal, and 27% temporal), which demonstrates the sensitivity of the white matter tracts of the optic radiation. 7 Kupersmith et al reported that spontaneous recovery occurred in 24% of visual field deficits after hemorrhage.…”

Section: Decision Making and Visual Fieldsmentioning

confidence: 87%

“…An annual risk of death due to untreated AVMs has been estimated to be 1%. 27 Thirty-six percent of patients in the present study presented with a hemorrhage, and 15 patients (9%) had a hemorrhage during the latency interval. This latency hemorrhage result equated to an annual hemorrhage risk rate of 2% and resulted in 9 deaths that were directly attributable to a hemorrhage.…”

Section: Decision Making and Visual Fieldsmentioning

confidence: 93%

Stereotactic radiosurgery for arteriovenous malformations of the postgeniculate visual pathway

Bowden

Kano

Caparosa

et al. 2015

JNS

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ManageMent options for arteriovenous malformations (AVMs) have expanded and evolved over time. However, the underlying goal of intervention remains complete obliteration of the AVM and maintenance of neurological function. 16,40,41 The rates of AVM occlusion after a single Gamma Knife surgery generally range from 70% to 80% over a 5-year observation period. 6,11,19,25 In addition, stereotactic radiosurgery (SRS) has a relatively low risk profile for adverse radiation effects (AREs). 23The lateral geniculate nucleus gives rise to the sublenticular and retrolenticular segments of the optic radiation that travel through the temporal and parietal lobes, respectively, on a path that terminates in the striate cortex. Because the distance and fragility of these pathways create the opportunity for disruption by an AVM, associabbreviatioNs ARE = adverse radiation effect; AVM = arteriovenous malformation; SRS = stereotactic radiosurgery. submitted January 8, 2014. accepted October 14, 2014. iNclude wheN citiNg Published online November 28, 2014; DOI: 10.3171/2014.10.JNS1453. disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. Dr. Lunsford is a consultant and stockholder for AB Elekta. , and 19 Gy (range 14-25 Gy) was the median margin dose. Obliteration of the AVM was confirmed in 80 patients after a single SRS procedure at a median follow-up of 74 months (range 5-297 months). The actuarial rate of total obliteration was 67% at 4 years. Arteriovenous malformations with a volume < 5 cm 3 had obliteration rates of 60% at 3 years and 79% at 4 years. The delivered margin dose proved significant given that 82% of patients receiving ≥ 22 Gy had complete obliteration. The AVM was completely obliterated in an additional 18 patients after they underwent repeat SRS. At a median of 25 months (range 11-107 months) after SRS, 9 patients developed new or worsened visual field deficits. One patient developed a complete homonymous hemianopia, and 8 patients developed quadrantanopias. The actuarial risk of sustaining a new visual deficit was 3% at 3 years, 5% at 5 years, and 8% at 10 years. Fifteen patients had hemorrhage during the latency period, resulting in death in 9 of the patients. The annual hemorrhage rate during the latency interval was 2%, and no hemorrhages occurred after confirmed obliteration. coNclusioNs Despite an overall treatment mortality of 5%, related to latency interval hemorrhage, SRS was associated with only a 5.6% risk of new visual deficit and a final obliteration rate close to 80% in patients with AVMs of the postgeniculate visual pathway.

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“…172 It is unclear whether 'blindsight' can be used for visual rehabilitation of visual cortex-injured adult patients. [172][173][174][175][176] Both Munk 19 and Schäfer 25 reported that adult monkeys and dogs showed some residual function following ablations of the visual cortex. In general, they found that more visual function was apparent in dogs than monkeys.…”

Section: Mechanisms Of Visual Recovery In Children With Cortical Visumentioning

confidence: 99%

Visual function in the brain-damaged child

Hoyt

2003

Eye

156

164

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Can visual function be restored in patients with homonymous hemianopia?

Cited by 116 publications

References 41 publications

Intravenous Thrombolysis in Ischemic Stroke Patients With Isolated Homonymous Hemianopia

Intravenous Thrombolysis in Ischemic Stroke Patients With Isolated Homonymous Hemianopia

Stereotactic radiosurgery for arteriovenous malformations of the postgeniculate visual pathway

Visual function in the brain-damaged child

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