O.S. (B) Horner's syndrome, left eye. It represents damage to the inferior optic radiating fibers (Meyers loop). By definition, an incomplete hemianopia spares at least part of the vision on the affected side. If there is extinction, patient receives a 1, and the results are used to respond to Webunilateral blindness or enucleation, visual fields in the remaining eye are scored. The sufferer is able to detect light within the damaged visual field. It may be homonymous (binasal, Foroozan, R. (2003). Patient with MLF syndrome cannot adduct the eye on attempted lateral conjugate gaze, and has nystagmus in abducting eye. Post-chiasmal lesions result in homonymous field defects, i.e., affecting the same side (right or left) of the visual field and respecting the vertical midline. What Is Quadrantanopia? NovaVision Quadrantanopia - Wikipedia Multidisciplinary evaluation and treatment including orbital or neurosurgery may be necessary depending on the underlying lesion producing the visual field defect. Note that half of the optic nerves cross at the optic chiasm, causing vision loss on one side to be quite different than that in one eye. A patient who experiences a large hole in the vision of the right eye immediately upon awakening may be quite different than the patient who noticed vision loss in one eye when the fellow eye was covered after a minor injury. 492-507, Posner JB: Intracranial metastases. The chiasm lies in the suprasellar cistern above the sella turcica, and is surrounded by the hypothalamus superiorly and the infundibulum and pituitary gland inferiorly[3]. The impacted uncus forces the contralateral crus cerebri against the tentorial edge (Kernohans notch) and puts pressure on the ipsilateral CN III and posterior cerebral artery. The response in the opposite eye is called the consensual pupillary light reflex. These field defects will cross neither the vertical midline nor the horizontal midline. It may have a THE VISUAL PATHWAY (Figure 17-1) includes the following structures. WebThe location (and frequency) of lesions causing superior quadrantanopias was occipital lobe (83%), parietal lobe (3%), and temporal lobe (13%). Abstract. 1. Arch Ophthalmol 2001 Dec;119(12):1788-94. By Alan G. Kabat, OD, and Joseph W. Sowka, OD. A normal scan sometimes turns out to be not so normal when re-evaluated with more critical parameters! The use of aspirin as a platelet anti-aggregant may be advisable in those with significant intracranial arterial stenosis. (1) Ipsilateral blindness. Vision restorative training (VRT) may provide a mechanism to regain visual function at the border of the visual field defect, although studies with this system have yielded conflicting and inconclusive results. Postganglionic sympathetic fibers pass through the tympanic cavity and cavernous sinus and enter the orbit through the superior orbital fissure. The visual pathway. What does the rest of the ocular examination reveal? Clinicians should be aware of the localizing value of specific visual field defects and perform neuroimaging to exclude a structural lesion including mass lesions[15]. However, other field defects, like a junctional scotoma or a junctional scotoma of Traquair, may occur[14]. The visual pathway from optic chiasm to striate cortex. Homonymous Hemianopsia, Symptoms, Causes, Diagnosis Visual fields are below. Slightly more than half the nasal pupil pathway fibers cross at the chiasm, so significant defects anterior to the chiasm cause an RAPD. Skenduli-Bala E, de Voogd S, Wolfs RC, et al. The temporal retinal processes the nasal visual field, while the nasal retina processes the temporal visual field. The section of the optic nerve at the optic chiasm transects all fibers from the ipsilateral retina as well as fibers from the contralateral inferior nasal quadrant that loop into the optic nerve. Hold the ND filter over the normal eye, and shine the light through the filter. Remember: Nearly half of the nerve fibers cross at the optic chiasm, so the loss of visual field on one side is quite different than loss of vision in one eye. WebUnilateral lesions can lead to homonymous hemianopias and scotomas. (7) Right hemianopia with macular sparing. Visual field loss increases the risk of falls in older adults: the Salisbury Eye Evaluation. Convergence remains intact. Journal of Glaucoma, 22 Suppl 5 Suppl 1, Proceedings of the 18th Annual Optic Nerve Rescue and Restoration Think Tank: Glaucoma and the Central Nervous System September 1617, 2011 New York, NY Sponsored by The Glaucoma Foundation (TGF), S2S7. Color vision, visual fields and extraocular motilities were normal in both eyes. Are There Any Natural Ways to Increase Breast Size? 1. Severity of visual field loss and health-related quality of life. Before formal visual field testing, however, you must determine several things. Such knowledge will enhance proper triage of these often-critical patients. and 20/200 O.S. Aside from these rare but critical cases, the most important testone that must not be skippedis automated perimetry. They project from the nasal hemiretina to the contralateral lateral geniculate body and from the temporal hemiretina to the ipsilateral lateral geniculate body. One exception to neurology referral is a patient with visual field loss that you suspect is psychogenic in origin. Quadrantanopia | definition of quadrantanopia by Medical dictionary In general, you can link the findings from color vision and pupil testing together. Friedman DS, Freeman E, Muoz B, et al. B. White light comparison testing showed a 25% sensitivity in the left eye as compared to the right. WebIf a lesion only exists in one unilateral division of the optic radiation, the consequence is called quadrantanopia, which implies that only the respective superior or inferior quadrant of the visual field is affected. Also important in the localization of visual field defects is the concept of congruity. F. The geniculocalcarine tract (visual radiation) projects through two divisions to the visual cortex. Visual outcome of a cohort of children with neurofibromatosis type 1 and optic pathway glioma followed by a pediatric neuron-oncology program. [8] Teaching individuals with quadrantanopia compensatory behaviors could potentially be used to help train patients to re-learn to drive safely. Reproduction in whole or in part without permission is prohibited. THE PUPILLARY DILATION PATHWAY (Figure 17 4) is mediated by the sympathetic division of the autonomic nervous system. Junctional Scotoma and Junctional Scotoma of Traquair, https://eyewiki.org/w/index.php?title=Compressive_Visual_Field_Defects&oldid=84398, Adults: breast, lung, unknown primary, prostate, melanoma, Children: neuroblastoma, Ewing sarcoma, leukemia, Rhabdomyosarcoma (embryonal type, children), Langerhans cell histiocytosis (<1% of all orbital masses), Fibromatosis (most common orbital lesion of infancy), Plasmacytoma/multiple myeloma (0.5% of all orbital masses), Benign (50%) - Benign mixed tumor (pleomorphic adenoma), Malignant (50%) - Epithelial carcinoma, Adenoid cystic carcinoma, Malignant mixed tumor, Metastasis, Neoplasm is the most common cause of chiasmal syndrome and is from both direct compression and inflammatory disruption of the vascular circulation to the chiasm, Pituitary Adenoma - most common cause of chiasmal lesion, Meningioma (including optic nerve sheath meningioma), Non-neoplastic etiologies can also cause direct compression at the chiasm, including, Vascular sources may cause compression and/or ischemia to the chiasm, Apoplexy - from either vascular sources or tumors, Aneurysm of anterior communicating artery or internal carotid artery, Trauma can rarely cause chiasmal syndrome from a frontal bone fracture and/or anterior skull base fracture and hematoma can act as a mass lesion. 1 = Partial hemianopia. Biomicroscopy revealed healthy anterior segment structures; dilated funduscopy showed moderate nonproliferative DR, but no evidence of neovascular scaffolding, vitreous hemorrhage or retinal detachment in either eye. Nearly one out of every 20 people past age 55 has visual field loss that is significant enough to impair daily functioning. This is considered a bitemporal visual field defect despite the extension into the superior nasal quadrant in the left field.How quickly does the referral need to be made? Instructions Scale Definition Score - National Institutes of Health What is left inferior quadrantanopia? It usually affects a Common and/or Classic Visual Field Patterns and Their Causes A. C. Contralateral homonymous hemianopia is caused by compression of the posterior cerebral artery, which irrigates the visual cortex. THE PUPILLARY LIGHT REFLEX PATHWAY (Figure 17-3) has an afferent limb. (II) Lower altitudinal hemianopia as a result of bilateral destruction of the cunei. Nerve fibers originating in the nasal retina cross at the level of the optic chiasm, traveling with contralateral temporal fibers to the lateral geniculate nucleus where they synapse. left, O.D. EvaluationExamination revealed corrected acuity of 20/25 OU. ), III. Time is critical! WebQuadrantanopia. Anterior chiasmal syndrome,or a lesion just anterior tothe chiasm on the same side as the eye with the central field defect. [citation needed], The prospects of recovering vision in the affected field are bleak. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Traumatic chiasmal syndrome: A meta-analysis. Visual field testing by confrontation demonstrated severe depression of the superior temporal quadrant of the left eye, but was also noted to affect the superior nasal quadrant of the right eye. Occasionally, patients will spontaneously recover vision in the affected field within the first three months after the brain injury; however, vision loss remaining after this period of spontaneous recovery is traditionally thought to be permanent, certain companies now claim to be able to induce recovery of vision after this three-month period. Kasten E, Bunzenthal U, Sabel BA. The treatment of the visual field defect depends on the underlying etiology. Lam BL, Thompson HS. Figure 17-4. 4. Ultimately, this patient was diagnosed with neurosyphilis, and was treated with penicillin. Unilateral quadrantanopia in a case of pituitary apoplexy The posterior area receives macular input (central vision). Douglas VP, Douglas KAA, Cestari DM. Some authorities place the "center" in the paramedian pontine reticular formation. The optic nerve projects from the lamina cribrosa of the scleral canal, through the optic canal, to the optic chiasm. Visual neglect (also called hemispatial neglect or unilateral This is considered a bitemporal visual field defect despite the extension into the superior nasal quadrant in the left field. Neoplasms in the region of the optic tract can produce contralateral incongruous homonymous hemianopia, often with a relative afferent pupillary defect and band atrophy of the optic nerve (in the eye with the temporal visual field defect). The bottom line: From a clinical standpoint, a right positive RAPD means that you should be looking for a problem in the right retina and/or optic nerve. Barton JJS. Depending upon the degree of the RAPD in the other eye, this may appear to even out the signals being carried in both afferent systems. All About Vision Consultation with the appropriate medical caregiver is prudent. White light comparison testing showed a 25% sensitivity in the left eye as compared to the right. It is caused by lesions of the retrochiasmal [citation needed], Individuals with quadrantanopia often modify their behavior to compensate for the disorder, such as tilting of the head to bring the affected visual field into view. If patient is blind from any cause, score 3. Due to the chiasm proximity to the pituitary gland, endocrine symptoms may present. Acute Vision Loss The clinical manifestations of orbital tumors may include gaze-evoked amaurosis (due to reduction in the flow of blood to the optic nerve and retina), proptosis, optic disc swelling (direct compression of the optic nerve), optociliary shunt (actually retinochoroidal venous collateral) vessels, and choroidal folds[13]. D. Horner's syndrome is caused by transection of the oculosyuipatheik; pathway at any level (see IV). The most common cause of an optic chiasm lesion is from a compressive source, and this is often neoplastic in nature[4]. Score 1 only if a clear-cut asymmetry, including quadrantanopia, is found. Townend BS, Sturm JW, Petsoglou C, et al. The late Larry Gray, OD, used to tell us visual fields read like a roadmap to the brain. The implication is, if you can understand the architecture of the pathways and the nuances of visual field defects, you can potentially pinpoint the precise location of the intracranial pathology. Looking right Looking left Eyes converged. Visual Field Defect Quadrantanopia - an overview | ScienceDirect Topics Parietal lobe lesion (infarct, hemorrhagic stroke, trauma)on the side opposite the visual field defect. McKean-Cowdin R, Wang Y, Wu J, et al. We learned this principle from professor Lou Catania, OD, quoting Hickams dictum: The patient may have as many diseases as he or she pleases.. Bilateral deficits are caused by chiasmal lesions or lesions affecting the retrochiasmal pathways. (F) Paralysis of upward gaze and convergence (Parinauds syndrome). E. Relative afferent (Marcus Gunn) pupil results from a lesion of the optic nerve, the afferent limb of the pupillary light reflex (e.g., retrobulbar neuritis seen in multiple sclerosis). Of course, this test should be interpreted relative to other potential findings, such as corneal edema, cataracts, or other conditions that can affect the patients perception of brightness. II. Spencer EL, Harding GF. right. Hypothalamic neurons of the paraventricular nucleus project directly to the ciliospinal center (T1-T2) of the intermediolateral cell column of the spinal cord. At todays visit, he reported a two-day history of vision loss, which developed abruptly. Note that the defect in the right (asymptomatic) eye strongly respects the vertical midline. clinical Visual field defects after stroke - Royal Australian The medial rectus subnucleus of CN III, which mediates convergence, VI. It occurs in syphilis and diabetes. 2. Such changes, among others, may indicate a cerebrovascular accident (stroke). 4. WebQuadrantanopia refers to the loss of vision in one of the quarters of the visual field. Retinitis pigmentosa. Neurology 2006; 66: pp. Zhang X, Kedar S, Lynn MJ, et al. Complete homonymous hemianopias have no localizing value, except to say that they are post-chiasmal.1. Most commonly, the nasal crossing fibers are affected, manifesting with a monocular temporal field defect in the ipsilateral eye. C. The superior cervical ganglion projects postganglionic sympathetic fibers through rhe perivascular plexus of the carotid system to the dilator muscle of the iris. Superiorquadrantanopia. F. Transtentorial (uncal) herniation occurs as a result of increased supra tentorial pressure, which is commonly caused by a brain tumor or hematoma (subdural or epidural). Loss of vision in a quarter of the visual field, Homonymous inferior/superior quadrantanopia, Kolb, B & Whishaw, I.Q. Effects of dipivefrin and pilocarpine on pupil diameter, automated perimetry and logMAR acuity. Optic nerve sheath meningioma. Figure 17-3. Visual pathway lesions If patient is blind from any cause, score 3. Transection of the upper division (A) results in right lower homonymous quadrantanopia. Patients with residual field deficit following stroke may benefit from vision rehabilitation, including such elements as prismatic correction and compensatory training to improve visual search abilities. 13. left, O.D. The visual pathway from the retina to the visual cortex showing visual field defects. Score 1 only if a clear-cut asymmetry, including quadrantanopia, is found. Field defects from damage to the optic nerve tend to be central, asymmetrical and unilateral; visual acuity is WebSudden unilateral quadrantanopia caused by retinal diseases often has characteristic presentations, such as acute onset and severe visual acuity defect. A 55-year-old black male with a history of Type 2 diabetes and hypertension presented urgently for evaluation. A trace relative afferent pupillary defect was seen O.S., but both pupils were of normal size. J AAPOS 2006; 10: pp. Davis, 1995. pp. History of cerebrovascular accident. If you do order neuroradiology studies for your patient, its a good idea to work with the neurologist the first few times so that you dont end up with equivocal results. Ring scotoma (usually bilateral). Visual radiation to lingual gyrus Visual radiation to cuneus. A. Webunilateral blindness or enucleation, visual fields in the remaining eye are scored. The visual field defect seen in the chiasmal syndrome is typically a bitemporal hemianopsia. Quadrantanopia Definition and Examples - Biology Online Dictionary The hypothalamus. Lesions of the medial longitudinal fasciculus (MLF) between the abducent and oculomotor nuclei result in medial rectus palsy on attempted lateral conjugate gaze and horizontal nystagmus in the abducting eye. 2 The condition may be Quadrantanopia definition and causes - Health Jade It projects through the geniculocalcarine tract to layer IV of the primary visual cortex (Brodmann's area 17). C. The superior colliculus and pretectal nucleus project to the oculomotor complex of the midbrain. Wilkins, 1997, p 261. It projects to the ipsilateral lateral geniculate body, pretectal nuclei, and superior colliculus. Reproduction in whole or in part without permission is prohibited. G. Papilledema (choked disk) is noninflammatory congestion of the optic disk as a result of increased intracranial pressure. Double simultaneous stimulation is performed at this point. The defect is usually bilateral as it is typically caused by a lesion past the optic chiasma. When patients display other neurological symptoms, an immediate referral is required. If the patient displays disturbances in speech, gait, memory, facial symmetry or behavior, an immediate referral to the ER is essential. He said he experienced unusual flashes of light, followed by a sudden darkening affecting his left eye. Complete hemianopia describes having no visual stimulus in half of their visual field. Premature Ejaculation Causes and Treatment, Anxiety and Panic Disorders Holistic Cure, Electromagnetic Radiation and Human Health, How to Improve Your Sex Life With Your Partner. One study found a five-fold increase of visual field loss between ages 55 and 80. Optic chiasm field defects Lesions at the optic chiasm are characterised by bitemporal hemianopia. Stroke. However, the etiology is less commonly from a congenital, traumatic, vascular, inflammatory, infectious, demyelinating, and infiltrative source[5]. Examining visual field defects in the paedriatric population exposed to vigabatrin. Mass effect is the compression of nearby structures by a mass (aneurysm, tumor, hematoma, abscess). Invest Ophthalmol Vis Sci 2007 Oct;48(10):4445-50. Optometric management depends on the extent of field loss and the degree of recovery following the stroke. left, O.D. The visual association cortex (Brodmann's area 19) projects through the cortico-tectal tract to the superior colliculus and pretectal nucleus. Koeller KK, Smirniotopoulos JG. The lower division (see Figure 17-2) loops from the lateral geniculate body anteriorly (Meyers loop), then posteriorly, to terminate in the lower bank of the calcarine sulcus, the lingual gyrus. and 20/80 O.S. The diagnosis can be made with the swinging flashlight test (see Figure 17-4A). Note that the defect in the right (asymptomatic) eye strongly respects the vertical midline. This syndrome consists of miosis, ptosis, apparent enophthalmos, and hemianhidrosis. Disorders of the visual pathway - Knowledge @ AMBOSS In: Neuro-ophthalmology. Arch Ophthalmol 2005 Feb;123(2):233-8. HVr6}WX0. Visual field manifestations can be variable within the orbit, depending on the location of compression and the fibers affected. Walsh & Hoyt's Clinical Neuro-Ophthalmology. The patient was referred to his primary care physician with a request for an MRI with contrast of the area in question, to be performed within 24 to 48 hours. [2], In a quadrantanopia that is partial, there also exists a distinct and sharp border between the intact and damaged field within the quadrant. left, O.D. WebThis loss is unilateral and homonymous: this implies that the visual deficit affects the same region of the visual field in both eyes; this is due to the fact that fibers from the nasal hemi-retinas (representing the lateral or temporal visual field) from each eye cross in the optic chiasm, while fibers from the temporal hemi-retina (representing It also receives fibers from the ipsilateral temporal hemiretina and the contralateral nasal hemiretina. Relations of the left upper and left lower divisions of the geniculocalcarine tract to the lateral ventricle and calcarine sulcus. Neglect is primarily a disorder of attention whereby patients characteristically fail to orientate, to Damage to the optic radiations in the temporal or parietal lobe results in a quadrantanopia, impacting the superior or inferior field, respectively. 2009;37(1):30-53. 2005 Mar 31.;352(13):1305-16. Vision was 20/20 O.D. The patient was advised that he had likely suffered an isolated stroke which caused him to experience vision loss. Lesions in the optic tract can also cause an RAPD in certain instances.17. Double simultaneous stimulation is performed at this point. His visual acuity recovered fully, but his visual fields only partially recovered. [1] While quadrantanopia can be caused by lesions in the temporal and parietal lobes of the brain, it 1. Pupils were normally reactive and ocular motilities were unrestricted. Stimulation (e.g., from an irritative lesion) causes contralateral deviation of the eyes (i.e., away from the lesion). bank of calcarine sulcus, Figure 17-2. Causes of a visual field defect that respects the horizontal midline (altitudinal visual field defects) are more frequently located anteriorly in the pathway (near the optic nerve or retina). Score 1 only if a clear-cut asymmetry, including quadrantanopia, is found. With inferior parietal lesions, quadrantanopia involves the lower quadrants of the field, with the side of the quadrant loss depending on the laterality of the lesion. Ask the patient to assign a brightness value of 100 points to that light. NINDS Know Stroke Campaign - NIH Stroke Scale The pressure cone forces the parahippocampal uncus through the tentorial incisure. Doc, Part of My Vision is Gone! - Review of Optometry Any complaint of headaches not explained by the exam. II. J Neuroophthalmol 1999 Sep;19(3):153-9. Post-geniculate fibers split into superior and inferior pathways, traveling through the parietal and temporal lobes, respectively, as they course posteriorly in the brain. neglect Identification of field loss using screening techniques. The upper division (Figure 17-2) projects to the upper bank of the calcarine sulcus, the cuneus. INTRODUCTION. (C) Internuclear ophthalmoplegia, right eye. Sometimes, however, the most obvious diagnosis is not the correct one. Type of field defect (Reprinted with permission from Fix JD: BRS Neuroanatomy. Hemianopsia - Wikipedia If patient is blind from any cause, score 3. Any complaint of a fixed missing spot in the visual field (monocular or binocular). Ophthalmology 2008 Jun;115(6):941-48.e1. For pathology affecting the post-chiasmal pathways, the accepted convention is that greater congruity is associated with more posteriorly located lesions. You can enhance the reliability of standard finger-counting testing by adding a facial Amsler test (have the patient fixate on your eyes and ask him or her if your other facial features appear distorted or are missing) and by performing double simultaneous stimulation confrontation fields. Lindenmuth KA, Skuta GL, Rabbani R, et al. Color vision, visual fields and extraocular motilities were normal in both eyes. There was a pronounced RAPD in the left eye with reduced color vision (1/14 plates) in the left eye only. Our thanks to the following individuals for helping to inspire this article: Mr. Matthew Hennen (SCO 16), Dr. Leah Stevens and Dr. Robert Goodwin (via ODs on Facebook). 2. Pelak VS, Dubin M, Whitney E. Homonymous hemianopia: a critical analysis of optical devices, compensatory training, and NovaVision. Edgar DF, Crabb DP, Rudnicka AR, et al. The response in the stimulated eye is called the direct pupillary light reflex. The difference between partial hemianopia and complete hemianopia is how much of a patients visual field is affected. [1] While quadrantanopia can be caused by lesions in the temporal and parietal lobes of the brain, it is most commonly associated with lesions in the occipital lobe. 2013 Feb;27(2):133-41. Optom Vis Sci 2004 May;81(5):298-307. The patient underwent neuroradiological evaluation, and a craniopharyngioma was found. Common and/or Classic Visual Field Patterns and Their Causes. Miller, Neil R., Newman, Nancy J. eds. 14. For pathology affecting the post-chiasmal pathways, the accepted convention is that greater congruity is associated with more posteriorly located lesions.1 However, this is not an absolute rule. Are there any other unassociated symptoms? 2014 Sep 22;8:1919-27. This occurs due to a lesion of the ipsilateral optic nerve, causing an optic neuropathy, and of the contralateral decussating inferior nasal retinal fibers, causing loss of the superior and temporal field in the opposite eye. Ed: Rosen ES, Eustace P, Thompson HS, et al. These fibers innervate the sphincter muscle of the iris. Graefes Arch Clin Exp Ophthalmol 1999 Feb;237(2):117-24. Right homonymous superior quadrantanopia. Light shincd into one eye causes both pupils to constrict. https://doi.org/10.1016/B978-0-323-52819-1.00237-1, Yoshihara MK, Lui F. Neuroanatomy, Bitemporal Hemianopsia. O.S. CN = cranial nerve. complaints. 12. Baltimore, Williams &. 2007 May;143(5):772-80. b. Lesions that involve both cunei cause a lower altitudinal hemianopia (altitud inopia). Quadrantanopia can also result in significant constraints of ones vision and ability to 906-910, Kedar S, Zhang X, Lynn MJ, et al: Pediatric homonymous hemianopia. When to do Automated Field Testing: E. The lateral geniculate body is a six-layered nucleus. Lesion at or near the optic chiasm (not always a pituitary adenoma). The locations and associated tumors along the visual pathway include: The orbit can be divided into 3 different zones: intraconal, extraconal, and intercompartmental. Suprasellar and sellar lesions can produce optic neuropathies in one or both eyes; a junctional scotoma (ipsilateral visual loss and contralateral superotemporal visual field loss) or the junctional scotoma of Traquair (monocular hemianopic visual field loss); or chiasmal bitemporal hemianopsia (including paracentral bitemporal hemianopsia from crossing macular fiber in posterior chiasm). If there is a complete lesion or compression at the optic nerve, patients may experience total monocular vision loss in the affected eye. https://doi.org/10.1097/00055735-200312000-00002, Lee AG, Johnson MC, Policeni BA, Smoker WR. Does the missing area or spot remain the same size, or does it change? (A) Relative afferent (Marcus Gunn) pupil, left eye. A trace relative afferent pupillary defect was seen O.S., but both pupils were of normal size. This syndrome is most commonly seen in multiple sclerosis. If there is damage to the optic nerve then complete unilateral anopia can develop. Natural course of visual field loss in patients with type 2 Usher syndrome. He later revealed hed been suffering from a headache on the right side, behind his ear (the occipital region). Kardon R, Kawasaki A, Miller NR. Temporal lobe INTRODUCTION. THE 9. Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. Bitemporal (either inferior or superior) quadrantanopia affects either the upper or lower outer visual quadrants in both eyes. Optic nerve and significant retinal disease in one eye can create color vision disturbances and positive RAPD results in that eye. Additionally, a comprehensive neurological evaluation was requested to rule out any additional compromise. The clinical manifestations of an optic chiasm lesion can manifest with varying visual field defects and decreased visual acuity. 2. Ask what the patient was doing when he or she first noticed the loss.