Tsokolas Georgios, Khan Hina, Tyradellis Straton, George Jithin, Lawden Mark
Ophthalmology Department.
Department of Neurology, Leicester Royal Infirmary, Leicester, LE1 5WW, United Kingdom.
Medicine (Baltimore). 2020 Jul 2;99(27):e20754. doi: 10.1097/MD.0000000000020754.
To describe an unusual case of binasal congruous hemianopia secondary to functional visual loss (FVL).
A 24 year-old male was referred originally by his optician at the Emergency Eye Department of the Leicester Royal Infirmary in October 2018 with visual field changes affecting the nasal field of vision in both eyes on routine eye examination. The patient reported ongoing headaches over the last 6 weeks to 8 weeks associated with simultaneous peripheral visual field changes. He also reported rapid loss of weight over the same period of time.
Binasal congruous hemianopia secondary to FVL.
Full past medical and ocular history was obtained. The patient underwent full ophthalmic examination including dilated fundoscopy. Visual acuity was recorded with Snellen Chart. Color vision was assessed with Ishihara plates. Peripheral vision was assessed with both Humphrey visual fields and Goldmann visual fields. Optical coherence tomography of the macula and discs was also performed. Neuroimaging investigations included Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI) of the Brain. Electrophysiology investigations included Electroretinogram and visual evoked potentials. Patient was also tested for syphilis.
Humphrey visual fields and Goldmann visual fields confirmed the presence of complete binasal field defects. Optical coherence tomography, electroretinogram, visual evoked potentials, CT, MRI were all unremarkable. Ocular examination was normal. Finally, syphilis serology was negative. After 1 year of follow-up, the visual field changes have remained the same.
To the best of our knowledge, this is the fourth case described in the literature with complete congruous binasal hemianopia due to FVL. We advocate thorough investigations with multimodal imaging of the fundus, neuroimaging and syphilis serology to exclude serious organic causes for binasal field defects prior to labeling such a field defect functional. Such patients may benefit from neuropsychological input to understand the psychological factors that may be contributing to the symptoms.
描述一例继发于功能性视力丧失（FVL）的双侧一致性偏盲的罕见病例。
一名24岁男性于2018年10月由其验光师转诊至莱斯特皇家医院急诊科，常规眼科检查发现其双眼视野改变影响鼻侧视野。患者报告在过去6至8周持续头痛，并伴有同时出现的周边视野改变。他还报告在同一时期体重迅速下降。
继发于FVL的双侧一致性偏盲。
获取了完整的既往病史和眼科病史。患者接受了全面的眼科检查，包括散瞳眼底检查。使用斯内伦视力表记录视力。使用石原氏色盲测试图评估色觉。使用汉弗莱视野分析仪和戈德曼视野计评估周边视野。还进行了黄斑和视盘的光学相干断层扫描。神经影像学检查包括脑部计算机断层扫描（CT）和磁共振成像（MRI）。电生理检查包括视网膜电图和视觉诱发电位。患者还接受了梅毒检测。
汉弗莱视野分析仪和戈德曼视野计均证实存在完全性双侧视野缺损。光学相干断层扫描、视网膜电图、视觉诱发电位、CT、MRI均无异常。眼科检查正常。最后，梅毒血清学检查为阴性。经过1年的随访，视野改变情况保持不变。
据我们所知，这是文献中描述的第四例因FVL导致完全一致性双侧偏盲的病例。我们主张在将这种视野缺损标记为功能性之前，通过眼底多模态成像、神经影像学和梅毒血清学进行全面检查，以排除双侧视野缺损的严重器质性原因。此类患者可能受益于神经心理学干预，以了解可能导致症状的心理因素。
