MedPix® Patient Chart - Case No: 13192 :: Imaging - Review Images

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History

Age: 42 :: Gender: man

Patient History

42 y.o. combat fighter pilot c/o "blind spot" - sudden onset of R. inferior quadrantanopsia six days ago – lasted about four hours. Previous Hx of a similar episode several years ago.

Exam


Physical Exam and Laboratory

Right inferior quadrantanopsia on formal visual field testing
G6PD deficiency


Imaging

Imaging - Review Images for PT: 13192

Findings


Summary of Findings

• Lateral geniculate body - abnormal signal and enhancement
• Additional periventricular lesions


Imaging

Imaging - Review Images for PT: 13192

Diffferential


Differential Diagnosis

• Multiple sclerosis
• Lyme disease
• ADEM (Acute Disseminated Encephalomyelitis)
• Sarcoidosis
• Vasculitis (SLE, etc.)


Imaging

Imaging - Review Images for PT: 13192

Diagnosis


Case Diagnosis

Dx: Multiple Sclerosis, quadrantanopsia


Dx Confirmed by: Clinical Hx and response to steroid therapy

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Followup


Followup and Treatment

This patient had an extensive workup. Lyme titers were negative. CSF did not show oligoclonal bands nor pleocytosis.

Discussion


Discussion for this Patient

The lateral geniculate body is supplied by the Anterior Choroidal Artery (AChA); and, ischemia could produce a hemianopsia usually in association with hemiplegia and hemianesthesia. [PubMed] [PubMed] [PubMed] [PubMed] [PubMed]

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Topic


Visual Fields, Differential Diagnosis

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Monocular Blindness - Optic nerve proximal to Chiasm

  • Retinal Detachment
  • Central Retinal Artery/Vein Occlusion
  • Optic Neuritis
  • Trauma
  • Tumor

    Bitemporal Hemianopsia - Suprasellar lesion behind chiasm
  • Pituitary Adenoma

    Homonymous Hemianoposia - Distal to Chiasm:
  • 40% Occipital, 25% Temporal, 5% optic tract and LGB
  • 70% infarcts, 15% neoplasms, 5% hemorrhage, ??% trauma
    >>>PCA infarct
    >>>MCA infarct
    >>>AChA infarct (Eur Neurol 2000;43(1):35-8)
    >>>Watershed Infarcts (Acta Med Scand 1984;216(4):417-22)
    >>>Carotid Dissection (J Neuroophthalmol 1999 Jun;19(2):136-9)
    >>>Chiropractic Manipulation (Am J Ophthalmol 1997 Jun;123(6):851-2)
  • Lateral Geniculate Body (LGB)
  • Occipital Infarct
    >>>Unilateral progressing to Bilateral (J Neurol Neurosurg Psychiatry 1983 Jan;46(1):78-80)

    Quandrantanopsia - Optic Radiations distal to LGB (Lateral Geniculate Body)

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    :: PT: 13192 :: :: 2 questions

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    History:
    42 y.o. combat fighter pilot c/o "blind spot" - sudden onset of R. inferior quadrantanopsia six days ago – lasted about four hours. Previous Hx of a similar episode several years ago.

    Exam:
    Right inferior quadrantanopsia on formal visual field testing
    G6PD deficiency

    Findings:
    • Lateral geniculate body - abnormal signal and enhancement
    • Additional periventricular lesions

    Differential:
    • Multiple sclerosis
    • Lyme disease
    • ADEM (Acute Disseminated Encephalomyelitis)
    • Sarcoidosis
    • Vasculitis (SLE, etc.)

    Diagnosis:
    Multiple Sclerosis, quadrantanopsia
    Confirmed by:Clinical Hx and response to steroid therapy

    Treatment and Followup:
    This patient had an extensive workup. Lyme titers were negative. CSF did not show oligoclonal bands nor pleocytosis.

    Discussion:
    The lateral geniculate body is supplied by the Anterior Choroidal Artery (AChA); and, ischemia could produce a hemianopsia usually in association with hemiplegia and hemianesthesia. [PubMed] [PubMed] [PubMed] [PubMed] [PubMed]

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    Case Contributor and Editor
    Topic Author: James G. Smirniotopoulos, M.D.
    		Submitted by: James G. Smirniotopoulos, M.D. - Author Info
    Case/Image Editor: Alice Boyd Smith - Editor Info
    Case Accepted: 2009-09-05 08:21:25-04 :: Revised: :: Submitted:
    COW: 496 :: CME Start: 20091103 :: CME End: 20110417 :: CME Review Due: 20121103
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