MRCP PACES Cranial Neuropathies Visual Field Defects
Visual Pathways. Credit: As eo, CC BY-SA 4.0, via Wikimedia Commons
  • Characterize the visual field defect
    • Neglect: with both eyes open, move both hands and ask the patient which is moving
    • Define field defect with a red hat pin
    • Monocular vision loss (complete retinal vein / retinal artery occlusion, vitreous haemorrhage, ischaemic optic neuropathy – giant cell arteritis, optic neuritis – demyelination)
    • Bitemporal hemianopia (optic chiasm – pituitary adenoma, craniopharyngioma, anterior communicating artery aneurysm, pituitary apoplexy)
    • Homonymous hemianopia with macula involvement (left optic tract)
    • Stroke, space-occupying lesions, trauma may all cause:
      • Superior quadrantinopia (temporal lobe)
      • Inferior quadrantinopia (parietal lobe)
      • Homonymous hemianopia with macula sparing (occipital lobe)
  • Other things to look out for:
    • Scars indicating previous craniectomy (previous stroke)
    • Scars indicating previous craniotomy (previous trauma or surgery to remove tumour)
    • Pronator drift for pyramidal weakness
    • Dysphasia to check for left hemispheric involvement (especially in right inferior quadrantinopia)
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