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We have studied 18 patients with relapsing-remitting multiple sclerosis (MS)who had symptomatic visual field defects due to retrochiasmal lesions. In 17,the lesion responsible was identified by magnetic resonance imaging (MRI),computed x-ray tomography(CT),or both.The lesion responsible involved the posterior optic radiations in eight cases,the optic tract and lateral geniculate nucleus in six,and the posterior limb of the internal capsule in three.The prognosis for recovery of the field defect was good; complete recovery occurred in14 patients,and only two showed no recovery at all.The striking characteristic of the lesions was that most were unusually large;indeed,many were detectable on CT as well as MRI.Half- field asymmetries of either amplitude or latency of the visual evoked potentials(VEPs),consistent with a postchiasmal lesion,were present in only five out of 13 patients acutely.In only three of these did the abnormality persist at follow-up.We conclude that only large postchiasmal lesions are likely to cause symptomatic homonymous field defects in MS, usually characterized by rapid recovery.Hemifield VEPs have a low sensitivity for the detection of postchiasmal as compared with prechiasmal abnormalities. |
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CAT scan
CAT scan,abnormal
evoked potentials
hemianopia
hemianopia,homonymous
MRI
MRI,abnormal
multiple sclerosis
optic radiation
optic radiation,lesion of
optic tract
optic tract,lesion of
prognosis
visual evoked response
visual field defect
visual fields
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