IMPORTANT: We currently have a number of bugs related to image cropping and are actively trying to resolve them. In the meantime, we have disabled cropping. Apologies for any inconvenience. Stay informed: radiopaedia.org/chat

Optic tract syndrome / infarct

Case contributed by Wen Jak Ma
Diagnosis probable

Presentation

Left homonymous hemianopia.

Patient Data

Age: 65 years
Gender: Female

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:

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

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.