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From the Departments of Ophthalmology (X.Z., S.K., N.J.N., V.B.), Neurology (N.J.N., V.B.), and Neurological Surgery (N.J.N.), Emory University School of Medicine; and Department of Biostatistics (M.J.L.), Rollins School of Public Health of Emory University, Atlanta, GA.
Address correspondence and reprint requests to Dr. Valérie Biousse, Neuro-ophthalmology Unit, Emory Eye Center, 1365-B Clifton Road, NE, Atlanta, GA 30322; e-mail: vbiouss{at}emory.edu
Objective: To describe the clinical characteristics and clinical-anatomic correlations of homonymous hemianopia (HH).
Background: Homonymous hemianopia impairs visual function and frequently precludes driving. Most knowledge of HH is based on relatively few cases with clinical-anatomic correlations.
Methods: 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.
Results: 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.
Conclusion: Homonymous hemianopia is usually secondary to stroke, head trauma, and tumors. Although the characteristics of visual field defects can be helpful in lesion location, specific visual field defects do not always indicate specific brain locations.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the March 28 issue to find the title link for this article.
See also page 901
Supported in part by a departmental grant (Department of Ophthalmology) from Research to Prevent Blindness, Inc., New York, NY, and by core grants P30-EY06360 (Department of Ophthalmology) from the National Institutes of Health, Bethesda, MD. N.J.N. is a recipient of a Research to Prevent Blindness Lew R. Wasserman Merit Award. X.Z. was supported by unrestricted educational grants from NovaVision and TEVA Neuroscience.
Disclosure: Dr. Newman is on the scientific advisory board of NovaVision.
Received July 20, 2005. Accepted in final form December 5, 2005.
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