Visual pathway deficits

Last revised by Dr Pir Abdul Ahad Aziz Qureshi on 02 Dec 2020

Visual pathway or visual field deficits are defects in visual space determined by the location of a lesion in the neurological visual pathway from eye to brain cortex. Understanding of the visual system is paramount 1:

  • retina or optic nerve
    • anopia or central scotoma (ipsilateral)
  • optic chiasm 2
    • anterior (at the junction with one of the optic nerves)
      • junctional scotoma (ipsilateral central scotoma with contralateral superotemporal/temporal field defect)
    • middle
      • bitemporal hemianopsia (central lesions involving crossing fibers; classic)
      • binasal hemianopsia (bilateral lesions involving noncrossing fibers; rare 3)
    • posterior (at the junction with one of the optic tracts)
      • scotomatous bitemporal hemianopsia
  • optic tract
    • homonymous hemianopsia
  • lateral geniculate nucleus
    • homonymous sectoranopia or hemianopsia
  • temporal lobe
    • homonymous upper quadrant defect ("pie in the sky" quadrantanopia)
  • parietal lobe
    • homonymous defect, denser inferiorly (inferior quadrantanopia)
  • occipital lobe 
    • complete
      • isolated homonymous defect (macular sparing)
    • lower bank
      • homonymous upper quadrantanopia with macular sparing
    • upper bank
      • homonymous lower quadrantanopia with macular sparing

Vison abnormalities other than visual field deficits can also help localize lesions 1:

  • retina, optic nerve, optic chiasm, or contralateral optic tract
    • relative afferent pupillary defect (Marcus-Gunn pupil)
  • bilateral lesions
    • occipital lobe
      • Anton syndrome (cortical blindness)
    • occipitoparietal
    • occipitotemporal
      • achromatopsia
      • prosopagnosia
  • left occipital lobe and angular gyrus
    • alexia without agraphia

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Cases and figures

  • Fig 1: optic pathways
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  • Fig 2 : anatomy of eye and extraocular muscles
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  • Figure 3: visual pathway
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