Presentation
Left homonymous hemianopia.
Patient Data
Age: 65 years
Gender: Female
From the case:
Optic tract syndrome / infarct
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Severe right optic tract atrophy. Along its course, there is a small bright T2/FLAIR focus in adjacent brain parenchyma, superior to it and choroid fissure, immediately lateral to cerebral peduncle. This is associated with minor cystic change, and subtle local volume loss, suggesting an infarct within the territory of PCA perforator.
Case Discussion
Etiologies of optic tract lesions:
- infarct (40%).
- tumors (32%)
- trauma (17%)
- demyelination (rare to be isolated involvement).
Blood supply:
- thalamic perforators of the posterior communicating artery
- branches of the anterior choroidal artery
Optic tract syndrome typically presents with the triad of:
- contralateral incongruous homonymous hemianopia
- contralateral relative afferent pupillary defect (RAPD) without loss of visual acuity or color vision in ipsilateral eye
- hemianopic optic nerve atrophy / band atrophy 1