Cases reported "Scotoma"

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1/219. On the visual disturbances associated with massive basal aneurysms.

    When massive basal aneurysms compromise the anterior visual pathways the resulting disturbances of vision are diverse and a firm clinical diagnosis is difficult. Because of the rarity of the condition, a critical analysis of the visual defects was made in five personally studied patients with large anterior basal aneurysms in an effort to clarify the clinical features of the disorder. These observations were related to those reported in larger series of patients by Jefferson and Bull. This study gives support to the opinion that the commonest visual defect seen with massive basal aneurysms is impairment of visual acuity, followed next in frequency by bitemporal hemianopia, and then by junction scotoma.
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keywords = visual
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2/219. Incongruous homonymous hemianopic scotoma.

    We report a patient presenting with incongruous homonymous hemianopic scotoma due to infarction in the territory of the lateral posterior choroidal artery. Imaging studies showed that the patient had a fresh infarct in the lateral geniculate body causing this unusual visual field defect.
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ranking = 0.125
keywords = visual
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3/219. Laser pointer maculopathy.

    PURPOSE: To report a case of macular damage from a laser pointer. METHOD: Case report. A 19-year-old woman had an acute reduction of visual acuity in the right eye after deliberately staring into a commercial class 2 laser pointer for approximately 10 seconds. RESULTS: The patient's best-corrected visual acuity was RE: 20/40, and she had two small pericentral scotomata, as well as a hypopigmented ring-shaped lesion in the fovea. Within 8 weeks, her visual acuity improved to 20/20 and visual field returned to normal, but a subjective relative decrease in brightness of objects viewed by the right eye was apparent. Retinal pigment epithelial abnormality persisted. CONCLUSIONS: Commercial laser pointers, commonly used for teaching and entertainment purposes, may cause notable macular damage if abused. Morphologically, this may manifest as foveal retinal pigment epithelial disturbance.
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ranking = 0.5
keywords = visual
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4/219. Dark spots in late-phase indocyanine green angiographic studies in a patient with presumed ocular histoplasmosis syndrome.

    PURPOSE: We analyzed indocyanine green (ICG) angiograms in a patient with presumed ocular histoplasmosis syndrome (POHS) complaining about "seeing spots" and decreased visual acuity in order to identify the pathologic process. patients AND methods: A 30-year-old caucasian man with clinical signs of POHS who had previously undergone laser photocoagulation for secondary choroidal neovascularization developed visual disturbances primarily in his temporal visual field. We performed fundus photography, fluorescein angiography and ICG angiography before, during and after the episode of visual disturbance. ICG angiographic findings were correlated to fundus photographs and fluorescein angiograms. RESULTS: Fundus examination, fluorescein angiograms and early-phase ICG angiograms were unremarkable at all time points. However, during the phase of visual disturbance, late-phase ICG angiographic study revealed hypofluorescent lesions in the area representing the visual disturbances. At 1 week follow-up, these hypofluorescent lesions were reduced in size and number; at 6 months follow-up they had completely resolved. CONCLUSIONS: Late-phase ICG angiographic study can provide additional information in inflammatory retinal disease by virtue of identifying areas of choroidal alterations while standard diagnostic examination remain unremarkable.
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ranking = 0.75
keywords = visual
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5/219. Visual field change in eyes with retinal pigment epithelial tear.

    PURPOSE: To study the effects of retinal pigment epithelial (RPE) deprivation on retinal sensitivity with serial automated static perimetry in cases of RPE tear involving the foveal area. methods: Two eyes with a tear of the RPE were diagnosed as such on biomicroscopic and fluorescein angiographic examination. Static perimetry was performed in the follow-up study with the Humphrey field analyzer central 10-2 program. RESULTS: The first patient showed a dense scotoma corresponding to a defect in the RPE, which showed mild deterioration throughout the follow-up period from 2-11 weeks after the development of RPE tear. In contrast, the second patient showed preserved visual acuity and an absence of central visual field defects, despite an apparently denuded bruch membrane involving the fovea during 8-month follow-up. CONCLUSION: Apparent RPE defect in eyes with RPE tears may or may not be associated with severe visual field defects. The pathophysiology of the disease should be studied, considering these perimetric findings.
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ranking = 0.375
keywords = visual
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6/219. The "thin man" phenomenon: a sign of cortical plasticity following inferior homonymous paracentral scotomas.

    AIM: To investigate an image distortion, experienced by patients with homonymous paracentral scotomas. methods: Two consecutive patients with right inferior homonymous paracentral scotomas resulting from ischaemic brain insults were examined. Neuro-ophthalmological examination included tangent screen and Amsler grid evaluation. In addition, the patients were asked to describe a figure showing two vertical lines, identical in length and symmetrically located on either side of a fixation point. This figure was presented in such a way that when the subject looked at the fixation point the right line crossed the scotoma. Finally, the patients were asked whether, when looking at the face of an interlocutor, both sides of the body looked the same. RESULTS: In both patients field defects were markedly smaller when delineated with Amsler grids than using a tangent screen. With the parallel line test, the right line appeared uninterrupted in patient 1, whereas in patient 2 it looked slightly blurred in a two degree long segment corresponding to the middle of the scotoma. To both subjects the right line appeared shorter than the left line. Finally both subjects indicated that, after steadily fixating their interlocutor's face or neck for 5-10 seconds, the left shoulder appeared narrower than the right one, which made him look surprisingly thin. This perceptual alteration was called the "thin man" phenomenon. CONCLUSIONS: Paracentral homonymous scotomas can be associated with perceptual completion and shape distortion, owing to apparent displacement of images adjacent to the scotoma towards the field defect. Occurrence of such a perceptual change should alert one to the possibility of paracentral homonymous scotomas, which often go undetected when using routine visual field testing procedures.
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ranking = 0.125
keywords = visual
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7/219. Surgical removal of subfoveal choroidal neovascular membranes in high myopia.

    BACKGROUND: A study was carried out to elucidate the anatomical and functional outcome after surgical excision of subfoveal choroidal neovascular membranes in high myopia. methods: Sixty-five patients with high myopia (> or =6 diopters), well-defined subfoveal neovascular membranes on fluorescein angiography and preoperative visual acuity < or =20/100 were selected for surgery. A standardized surgical technique was used in all cases, by a single surgeon. The main outcomes assessed were Snellen visual acuity, surgical retinal pigment epithelium defect and postoperative perfusion of the choriocapillaris. Multifactor analysis of variance and chi-square/Fisher's exact test statistics were used to assess the association between patients' pre- and postoperative characteristics and outcome measures. RESULTS: Follow-up ranged from 6 to 48 months (mean 16 months). Mean postoperative visual acuity (0.18) was significantly better than mean preoperative visual acuity (0.09). visual acuity improved by at least two lines in 29 eyes (45%) and was unchanged in 24 (37%). overall, 43 eyes (66%) had visual acuity of 20/200 or better and 15 (23%), 20/60 or better. Predictive factors with a significant effect on final visual acuity were mean visual acuity, preoperative status of retinal pigment epithelium and postoperative perfusion of the choriocapillaris. Postoperative perfusion was detected in 31 (48%) of the total 65 eyes and in 12 (67%) of the 18 eyes with normal retinal pigment epithelium at baseline. The mean postoperative retinal pigment epithelium defect was 4.6 times larger than the original neovascular membrane. In selected patients, SLO macular scotometry showed areas of retained retinal sensitivity within the atrophic scar. CONCLUSION: The natural history of subfoveal neovascularization in high myopia is rarely visually restorative. By contrast, surgical excision of the membranes is feasible and may restore visual acuity in selected patients. This therapeutic approach merits a formal multicenter clinical trial.
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ranking = 1.125
keywords = visual
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8/219. Compression of the prechiasmatic optic nerve produces a junctional scotoma.

    PURPOSE: To demonstrate the clinical-radiologic correlation between a junctional scotoma and a focal lesion compressing the prechiasmatic segment of the distal optic nerve. methods: Case report involving a man with a pituitary adenoma. Clinical correlation was determined by reviewing visual field evaluations and magnetic resonance images. RESULTS: The tumor compressed the prechiasmatic segment of the distal optic nerve but not the optic chiasm, producing a junctional scotoma documented by Goldmann and automated perimetry. The visual field defect resolved after neurosurgical decompression of the anterior visual pathway. CONCLUSIONS: A junctional scotoma can be caused by focal as well as large and diffuse lesions injuring the anterior visual pathway, specifically at the junction of the optic nerve and chiasm. This finding supports the existence of Wilbrand fibers.
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ranking = 0.5
keywords = visual
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9/219. Clinical and immunocytochemical findings in a case of melanoma-associated retinopathy.

    OBJECTIVE: To describe an unusual case of melanoma-associated retinopathy (MAR). DESIGN: Retrospective, observational case report and experimental study. PARTICIPANTS: A 61-year-old man with a history of cutaneous melanoma, acquired bilateral central scotomas, and night blindness. INTERVENTION: Serial full-field electroretinography (ERG) and Goldmann perimetry were performed. serum was screened for cancer-associated retinopathy (CAR) antibodies by Western blotting. Sections of human and rat retina were examined by immunofluorescence microscopy to determine whether retinal cells were reactive with this patient's serum. A metastatic workup was performed. MAIN OUTCOME MEASURES: electroretinography, Goldmann visual field testing, and immunocytochemistry were performed. RESULTS: The results were as follows: (1) The ERG showed a profound loss of the b-wave amplitude and a "negative" b-wave characteristic of congenital stationary night blindness; (2) a central scotoma and peripheral constriction were identified on Goldmann visual field tests; (3) as in other patients with MAR, bipolar cells in human and rat retinas were immunolabeled with this patient's serum; and (4) a previously unsuspected focus of metastatic melanoma was discovered. CONCLUSIONS: Recognition of this condition may help to identify an occult focus of metastatic melanoma.
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ranking = 0.25
keywords = visual
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10/219. Pathological perceptual completion in hemianopia extends to the control of reach-to-grasp movements.

    The neuropsychological phenomenon of blindsight is observed when patients who are cortically blind exhibit residual visual processing capabilities for stimuli presented within their scotoma to which they are otherwise unaware. Cortically blind patients may also exhibit the phenomenon of pathological visual completion in which, paradoxically, they can become aware of a complete visual stimulus even when a significant portion of that stimulus falls within their blind hemifield. In this study, the ability of a blindsight patient (G.Y.) to use visual information to control reach-to-grasp movements to static objects presented within his blind hemifield was investigated. The results indicate that while G.Y. was insensitive to variations in object size when reaching for objects presented entirely within his blind hemifield, his ability to accurately grasp objects located within his blind field was vastly improved if part of the object to be grasped extended into his seeing hemifield. This finding demonstrates that visual awareness can facilitate the visuomotor processing of object form within G.Y.'s apparently blind field, and suggests that the primary deficit in blindsight may be an impairment of visual consciousness rather than an absolute loss of visual function.
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ranking = 0.875
keywords = visual
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