The stroke team found the patient awake and alert but with a decreased gag reflex, dysarthric with acute left hemiparesis with no sensation in the left upper or lower extremities, and a left homonymous hemianopsia
1,2,4) Examples of previously reported presentations include cranial nerve palsies, (5,6) dysphagia, (7) homonymous hemianopsia
, (8) seizures, (9,10) and obstructive hydrocephalus, (2,11-13) as in the current case.
Evaluation of the visual fields showed left homonymous hemianopsia
The visual loss persisted, and the patient was referred by his local physician to an ophthalmologist, who noted significant left homonymous hemianopsia
on visual field testing.
Contralateral homonymous hemianopsia
is the usual symptom associated with superficial occlusion of a PCA.
Neurologic examination at the time of psychiatric consultation is notable for waxing and waning expressive aphasia, right homonymous hemianopsia
, and mildly decreased strength in the left biceps and forearm.
Robert opened his eyes spontaneously, had a right homonymous hemianopsia
and bilateral facial weakness.
On neurologic examination, the patient had a right homonymous hemianopsia
, optic nerve atrophy, and major visual impairment (left eye--20/100; right eye--20/200).
25,11,18] Homonymous hemianopsia
is the most emphasized complication, because of the close proximity of the pallidal lesions to the optic tract, but its incidence has been reduced by improved stereotactic techniques.
Both right and left homonymous hemianopsias
are common and can significantly interfere with reading and mobility (Kerkhoff, 2000).