Abstract Details

Title Homonymous Hemianopia with a Normal MRI: When To Consider Retinal Mimics of Suspected Neurologic Vision Loss

Topic Neuro-ophthalmology/Neuro-otology

Presentation(s) P02 - (-)

Poster/Presentation
Number 259

Objective

Background BACKGROUND: A 34 year old man with history of retinal detachment presented with progressive, painless vision loss in his left eye over 5 days. He noticed pulsating in his missing visual field, but no flashes or floaters. Examination by a retina specialist was remarkable for nasal hemi-field loss in his left eye.

Design/Methods DESIGN/METHODS: Neuro-ophthalmologic examination showed visual acuity of 20/15 OU, normal color vision, a 0.6 log unit relative afferent pupillary defect OS and normal posterior examination. Humphrey visual fields showed a nasal defect OS and temporal defect OD, suggestive of an incongruous homonymous hemianopia. Over the next five days, his vision OS worsened, with photopsias, headache, and photophobia. Repeat examination showed normal visual acuity and color vision OD and 20/800 and no color vision OS, with a >1.8 log unit RAPD OS. There was mild attenuation of the arteries OS with mottling of the macula, and normal disc appearance.

Results RESULTS: MRI and laboratory testing were unremarkable. Full-field electroretinogram showed global cone receptor dysfunction OU. Red-free photographs showed a white outer retinal irregular annular band of deep retinal opacification corresponding to his central scotoma OS. He was started on valacyclovir.

Conclusions CONCLUSIONS: Despite his examination and visual fields being initially concerning for a post-chiasmal lesion, his eventual diagnosis was acute annular outer retinopathy, a suspected variant of acute zonal occult outer retinopathy (AZOOR). Bilateral involvement is rare and it is an important consideration in the differential diagnosis of sudden unilateral or bilateral vision loss.

Authors/Disclosures
Aimee Szewka, MD, FAAN (Rush University Medical Center) PRESENTER	Dr. Szewka has nothing to disclose.
Carlo Pozzilli	Carlo Pozzilli has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Carlo Pozzilli has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Carlo Pozzilli has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck. Carlo Pozzilli has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion.

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