bounceback: vision loss

hemianop

Two bounceback cases highlighted the importance of considering occipital stroke and examining for visual field defects

CASE 1

47F HTN/lipid c/o decreased vision left eye

O/E decreased visual field left eye, sent to ophtho

Ophtho found homonymous hemianopsia, send back for CT: occipital infarct

 

CASE 2

61M HTN/smoke c/o decreased peripheral vision right eye

CT head normal, referred to ophthalmology

ophtho found bilateral visual field defect, sent back

MRI: occipital infarct

 

LESSON

  1. Remember your carefully assess visual fields, especially in patients with stroke risk factors. What patients described as “reduced vision in one eye” may actually be reduced visual field loss from an occipital lesion.
  2. if you’re concerned about occipital stroke don’t be reassured by a normal CT, get an MRI

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