Case History #46
Date of Consultation: 2-4-1982
HISTORY OF PRESENT ILLNESS:
This 28-year-old right-handed white female state worker was referred for neurologic consultation due to a visual problem. The patient was asymptomatic without any knowledge of visual problems until she visited an optometrist 3 months prior to consultation. The optometrist did routine visual field testing and demonstrated a left-sided visual field deficit. He recommended that a neurologic evaluation be undertaken. The patient was entirely unaware of any problems with her vision.
NEUROLOGICAL EXAMINATION:
Mental Status Exam: Intact.
Cranial Nerves: Cranial nerve examination was entirely normal except for the following. Visual field testing revealed the inability to see objects in the left superior quadrant of the visual field of each eye. Visual acuity was 20/20 without glasses, and funduscopic examination was entirely normal. There was no abnormality of pupillary function or external ocular movements.
Motor System: Intact.
Reflexes: Intact.
Sensory System: Intact.
Cerebellar Function: Intact.
Gait and Stance: Intact.
Questions:
1. How would you describe this patient's visual field deficit?
2. Damage to what area(s) of the brain could give rise to such a visual field defect? Be sure to indicate the side of the brain involved.
3. What specific structures are involved by the pathologic process in this case?
4. In general, what type of pathologic process was involved in this case?
5. What diagnostic procedure(s) would you undertake at this point?