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JAMA Ophthalmology Clinical Challenge
November 4, 2021

Homonymous Hemianopia With Normal Neuroimaging

Author Affiliations
  • 1Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
  • 2Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  • 3Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
  • 4Neuro-Ophthalmology Unit, Kensington Vision and Research Centre, Toronto, Ontario, Canada
JAMA Ophthalmol. Published online November 4, 2021. doi:10.1001/jamaophthalmol.2021.3356

A 46-year-old man presented with a 2-week history of a persistent blurred area in his right lower visual field of both eyes. He noticed colors surrounding the dark area that lasted 2 to 3 minutes at a time and occurred multiple times per day. His medical history was significant for dyslipidemia for which he took rosuvastatin. He also reported feeling lethargic, with polydipsia and a dull mild holocephalic headache during this period. Ophthalmological examination revealed a visual acuity of 20/20 OU, pupils were equal and reactive to light with no relative afferent pupillary defect, and color vision was normal. Dilated fundus examination was normal. Humphrey 24-2 Swedish interactive threshold algorithm fast visual field testing revealed a right homonymous hemianopia denser inferiorly (Figure, A). An urgent noncontrast computed tomography (CT) scan of the head was obtained and was normal (Figure, B). Magnetic resonance imaging (MRI) of the brain was initially reported as normal but revealed subtle abnormal T2/fluid-attenuated inversion recovery hyperintensity involving the left occipital cortex after further review (Figure, B).

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    1 Comment for this article
    Hyperglycemia in acute neurological deficits and normal imaging
    Khichar Shubhakaran, M.D.,D.M.(Neurology) | MDM hospital, Dr. S. N. Medical College, Jodhpur
    A nice case report worth discussion. Frequently we find one or the other acute neurological deficits specially the extrapyramidal features like chorea etc. and, hemiparesis where the initial changes may not be visible or at times they are transient. So is such cases the blood sugar level and ketone bodies in urine may give a clue regarding diabetic hyperglycemic hyperosmolar or ketoacidosis.