Homonymous hemianopia (HH) impairs visual function and frequently precludes driving.
Most knowledge of HH is based on relatively few cases with clinical-anatomic correlations.
The objective of this study was to describe the clinical characteristics and clinical-anatomic
correlations of HH. The authors reviewed medical records of all patients with HH seen
in their service between 1989 and 2004. Demographic characteristics, characteristics
of visual field defects, causes of visual field defects, neuroradiologic definition
of lesion location, and associated neurologic deficits were recorded. A total of 904
HH were found in 852 patients. A total of 340 HH (37.6%) were complete and 564 HH
(62.4%) were incomplete. Homonymous quadrantanopia (264 HH, 29%) was the most common
type of incomplete HH, followed by homonymous scotomatous defects (116 HH, 13.5%),
partial HH (114 HH, 13%), and HH with macular sparing (66 HH, 7%). A total of 407
HH (45.0%) were isolated. Causes of HH included stroke (629 HH, 69.6%), trauma (123,
13.6%), tumor (102, 11.3%), brain surgery (22, 2.4%), demyelination (13, 1.4%), other
rare causes (13, 1.4%), and unknown etiology (2, 0.2%). The lesions were most commonly
located in the occipital lobes (45%) and the optic radiations (32.2%). Every type
of HH, except for unilateral loss of temporal crescent and homonymous sectoranopia,
was found in all lesion locations along the retrochiasmal visual pathways. This study
shows that HH is usually secondary to stroke, head trauma, and tumors. The authors
conclude that although the characteristics of visual field defects can be helpful
in lesion location, specific visual field defects do not always indicate specific
brain locations.—Author’s abstract
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Published online: June 30, 2006
© 2006 Elsevier Inc. Published by Elsevier Inc. All rights reserved.