Vascular accidents affecting the eye and the visual pathways are not uncommon, and the sequelae vary according to the extent and the site of the lesion. The ocular changes may be but a small part of an extensive lesion causing gross disturbances of motor and of sensory function. One may have paralysis of conjugate deviation, oculomotor palsies or complete or incomplete homonymous defects in the visual fields. Frequently the lesion can be located with anatomic precision but without much benefit to the patient.
Hemianopsia of vascular origin is usually sudden in onset and is caused by an embolus, thrombosis or rupture of a vessel supplying the optic pathways or the visual cortex. Such defects are fairly common and unless complete frequently pass unnoticed and are only discovered on a routine examination of the visual fields. The occurrence of bilateral hemianopsia with sparing of the macular field is, however, rather rare.
McDONALD PR. BILATERAL THROMBOSIS OF POSTERIOR CALCARINE ARTERIES WITH SPARING OF MACULAR VISION. Arch Ophthalmol. 1943;29(1):92–97. doi:10.1001/archopht.1943.00880130112007
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