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JAMA Ophthalmology Clinical Challenge
April 16, 2020

Homonymous Hemianopia With Normal Magnetic Resonance Imaging

Author Affiliations
  • 1Wilmer Eye Institute, Division of Neuro-Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 2Department of Ophthalmology, Duke Eye Center, Durham, North Carolina
  • 3Royal College of Surgeons in Ireland, Dublin, Ireland
JAMA Ophthalmol. 2020;138(6):702-703. doi:10.1001/jamaophthalmol.2020.0447

A man in his 80s presented with 3 months of painless progressive vision loss, followed by gait changes, memory loss, and 10-lb unintentional weight loss. Medical history was notable for coronary artery disease, hypothyroidism, and prostate cancer in remission.

On ophthalmic examination, visual acuity was hand motion OU (baseline from 9 months prior was 20/50 OD and 20/30 OS), with briskly reactive left pupil and trace right relative afferent pupillary defect. He could detect 2/4 gross colors in the right eye and 1/4 gross colors in the left eye. Confrontation visual fields revealed dense right homonymous hemianopia with additional asymmetric deficits on Goldmann perimetry (Figure 1). Extraocular movements were full with gaze-evoked nystagmus. Horizontal vestibulo-ocular reflex, assessed by head impulse testing, was normal. Slitlamp and dilated fundus examination revealed pseudophakia and mild epiretinal membrane in the right eye and mild nuclear sclerosis in the left eye.

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    1 Comment for this article
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    Homonymous Hemianopia With Normal Magnetic Resonance Imaging
    Narayanaswamy Venketasubramanian, MB,BS | Raffles Neuroscience Centre, Raffles Hospital, Singapore
    Thank you for this very illustrative case. May I ask if the MRI brain included DWI sequences?, as it may show increased occipital cortical ribboning in this CJD variant.

    Thank you again

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