Zhang Xiaojun, Kedar Sachin, Lynn Michael J, Newman Nancy J, Biousse Valérie
Departments of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA.
J Neuroophthalmol. 2006 Sep;26(3):180-3. doi: 10.1097/01.wno.0000235587.41040.39.
Previous reports have suggested that most cases of homonymous hemianopia (HH) are caused by occipital stroke. However, these reports have not always been supported by brain imaging.
We reviewed the medical records of all patients seen in our unit between 1989 and 2004 who had HH documented by formal perimetry or confrontation visual fields and had undergone brain imaging. HHs were divided into those caused by stroke and by non-stroke conditions. The clinical and visual field characteristics were compared in the two groups.
Among 850 patients with 902 HHs, 629 (69.7%) resulted from stroke, of which 531 (84.4%) were from infarction and 98 (15.6%) from primary intraparenchymal hemorrhage. Non-stroke causes included head trauma (123), brain tumor (102), neurosurgical procedures (22), multiple sclerosis (13), and miscellaneous conditions (13). Occipital lesions most commonly resulted from stroke. The configuration of the HH did not predict where in the retrochiasmal visual pathway the responsible lesion lay.
Ischemic stroke causes most HHs from lesions in the occipital lobe that generally do not produce other neurologic manifestations. The configuration of the HH does not predict the location of the lesion within the retrochiasmal visual pathway.
既往报告提示，大多数同向性偏盲（HH）病例由枕叶卒中引起。然而，这些报告并非总能得到脑成像的支持。
我们回顾了1989年至2004年间在我院就诊的所有患者的病历，这些患者经正式视野计检查或面对面视野检查记录为HH，并接受了脑成像检查。HHs分为由卒中和非卒中情况引起的两类。比较两组的临床和视野特征。
在850例患有902个HHs的患者中，629例（69.7%）由卒中引起，其中531例（84.4%）由梗死引起，98例（15.6%）由原发性脑实质内出血引起。非卒中原因包括头部外伤（123例）、脑肿瘤（102例）、神经外科手术（22例）、多发性硬化（13例）和其他情况（13例）。枕叶病变最常见于卒中。HH的形态并不能预测负责病变位于视交叉后视觉通路的何处。
缺血性卒中导致大多数HHs是由于枕叶病变，这些病变通常不会产生其他神经系统表现。HH的形态不能预测病变在视交叉后视觉通路内的位置。
