42 y.o. combat fighter pilot c/o "blind spot" - sudden onset of R. inferior quadrantanopsia six days ago â€“ lasted about four hours. Previous Hx of a similar episode several years ago.
Right inferior quadrantanopsia on formal visual field testing
â€¢ Lateral geniculate body - abnormal signal and enhancement
â€¢ Additional periventricular lesions
â€¢ Multiple sclerosis
â€¢ Lyme disease
â€¢ ADEM (Acute Disseminated Encephalomyelitis)
â€¢ Vasculitis (SLE, etc.)
Dx: Multiple Sclerosis, quadrantanopsia
Dx Confirmed by: Clinical Hx and response to steroid therapy
This patient had an extensive workup. Lyme titers were negative. CSF did not show oligoclonal bands nor pleocytosis.
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]
Monocular Blindness - Optic nerve proximal to Chiasm
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