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Visual field defects after missile injuries to the geniculo-striate pathway in man

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Summary

Visual fields (defined by detection thresholds for moving and stationary targets) were examined in 10 cases of homonymous field defects due to retrochiasmal lesions. Using the Tübingen Perimeter, results of multiple perimetric methods could be compared quantitatively at identical retinal areas. The principal finding was one of thorough-going association of deficits: no instances of selective impairment of motion detection, flicker resolution, or regional dark adaptation were encountered. Pupillary reactivity to low-intensity light was depressed in areas of homonymous scotoma, as long as care was taken to avoid stimulation of relatively more intact regions of the visual field by scattered light. In the only case showing extreme difficulties in visual recognition (“agnosia”) for faces and objects there were unusually severe reductions in differential light detection thresholds, and in all other “elementary” visual functions. One half of the cases showed small homonymous scotomata with a sharp decrease of light sensitivity. They were often located in a perifoveal region that was otherwise normal. Field defects bordering on the midvertical meridian followed this meridian closer and tended to have steeper borders than those bordering on the midhorizontal meridian. Sparing of foveal vision (averaging 1.5°) was the rule but the spared region had reduced sensitivity. “Splitting” of the fovea was found in one case. Incongruence of homonymous field defects was greater for peripheral defects than for those near the center of the field; usually nasal fields showed larger defects than temporal. This tendency was enhanced by the sparing of parts of the monocular crescent in three cases.

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Additional information

Work was supported in part by grants to Dr. F. Koerner, Tübingen, from Foundation Fund of Research in Psychiatry (FFRP grant G 69-447) and by grants to Professor H.-L. Teuber, M.I.T., from the Alfred P. Sloan Foundation, from NASA (NGR-22-009-308), and from the National Institute of Mental Health under a program grant, MH-05673. The follow-up examinations of patients in this study were facilitated by NIH-Clinical Research Center grant FR-88, to M.I.T.

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Koerner, F., Teuber, H. Visual field defects after missile injuries to the geniculo-striate pathway in man. Exp Brain Res 18, 88–113 (1973). https://doi.org/10.1007/BF00236558

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Key words

  • Visual field
  • Brain injury
  • Visual agnosia
  • Pupillomotor perimetry
  • Flicker fusion
  • Perimetric methods