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Klinische Anwendung der visuell evozierten Potentiale zur Untersuchung von chiasmatischen und postchiasmatischen Läsionen

Clinical applications of visual evoked potentials for detection of chiasmal and postchiasmal lesions

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Summary

Visual evoked potentials (VEP) were recorded in 18 patients with pathologic processes confirmed by computerized tomography in the chiasmal (n=9) and parietooccipital region (n=9). Reactions from the right and left hemisphere could be recorded separately in spite of using a simple one-channel apparatus and electrodes only at Oz and Cz. In 17 cases changes of the VEP provided information concerning the localization and extension of the lesion.

In chiasmal processes we found a prolongation of monocular latencies, and a delayed or extinguished reaction to half-field stimulation from temporal retinal areas. However, the VEP was often pathologic for half-field stimulation of the nasal hemiretina. Pathologic VEPs were not always accompanied by visual field defects.

In contrary to patients with chiasmal processes no pathologic reaction could be found to full-field stimulation in parieto-occipital lesions. Only when the affected hemisphere was stimulated selectively were diminution of amplitudes, prolongation of latencies, or extinguished responses observed. The VEP changes were uniform despite the cause of the lesion (tumor, ischemia).

In chiasmal and parieto-occipital processes the VEP supplements computerized tomography by detecting deficits in function. This method appears suitable for monitoring the course of disease before and after neurosurgery.

Zusammenfassung

Visuell evozierte Potentiale (VEP) wurden bei 18 Patienten mit computer-tomographisch nachgewiesenen pathologischen Veränderungen im Bereich der Sella (n=9) und parieto-occipital (n=9) abgeleitet. Die Reizantwort der rechten und linken Hemisphäre konnte durch selektive Stimulation (Halbfeldreizung) trotz nur einkanaliger Ableitung mit Elektroden in der Mittellinie getrennt registriert werden. So konnten in 17 Fällen VEP-Veränderungen nachgewiesen werden, die Rückschlüsse auf Ort und Ausmaß der Läsion zuließen. Bei den Chiasma-Prozessen fand sich eine Verzögerung der monocularen Latenzen, sowie verzögerte bis aufgehobene Reizantwort bei Halbfeldstimulation von temporal (nasale Retinafasern). Auch bei Halbfeldstimulation von nasal (temporale Retinafasern) zeigten sich in vielen Fällen pathologische VEP-Antworten. Die VEP-Veränderungen gingen nicht immer mit Gesichtsfeldausfällen einher.

Im Gegensatz zur Gruppe der chiasmanahen Prozesse fanden sich bei den parieto-occipitalen Läsionen bei Vollfeldreizung kein pathologischer Befund, erst bei selektiver Halbfeldreizung der betroffenen Hemisphäre konnten Amplitudenminderung, Latenzzeitverzögerung und aufgehobene Reizantwort gefunden werden. Zwischen ischämischen Insulten und Tumoren war kein Unterschied festzustellen. Das VEP kann die Computer-Tomographie ergänzen, da es Funktionsausfälle nachweisen kann, so daß die Methode auch zur Verlaufsbeobachtung (prä- und postoperativ) geeignet erscheint.

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  1. Abteilung für Neurologie der Universität Ulm, Schwendi, Bundesrepublik Deutschland

    Luis Miguel Camacho, Wilhelm Wenzel & Jürgen Aschoff

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  1. Luis Miguel Camacho
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  2. Wilhelm Wenzel
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  3. Jürgen Aschoff
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Camacho, L.M., Wenzel, W. & Aschoff, J. Klinische Anwendung der visuell evozierten Potentiale zur Untersuchung von chiasmatischen und postchiasmatischen Läsionen. Arch Psychiatr Nervenkr 230, 243–256 (1981). https://doi.org/10.1007/BF00344449

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  • DOI: https://doi.org/10.1007/BF00344449

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