Homonymous hemianopia due to stroke presenting symptoms and lesion locations
Reviewed by Lauren Hepworth

A retrospective case notes review was undertaken of patients diagnosed with homonymous hemianopia following a radiologically confirmed stroke. A total of 85 patients were identified by searching an electronic medical records system over an 11-year period. Data were extracted from the medical notes including association with a surgical / medical procedure in the preceding 72 hours, presence of symptoms before and after stroke, details of vision symptoms, presence of persistent non-vision symptoms and the neurological examination findings. The majority of cases (90%) did not report any symptoms preceding their stroke event. There was no pattern to the time of day when patients became aware of their visual symptoms. In 20% of cases there were medical or surgical events in the preceding 72 hours which could have been contributory. Only 86% reported symptoms of the new visual impairment; in five cases family members reported noticing an issue, four had other stroke sequelae and three had the visual impairment detected as part of a routine eye exam. The authors present how patients reported their symptoms in their words – the majority reported solely negative symptoms. Only 68% were able to lateralise their visual impairment to the right or left side. Less than half had non-visual symptoms which accompanied the visual impairment, and a quarter had non-visual stroke sequelae identified on examination. The stroke lesions in less than half of cases were confined to the occipital lobe. The authors acknowledge study limitations related to its retrospective nature. They also acknowledge this study replicates the findings of other previous studies, however more detail is provided regarding how patients describe their presenting symptoms.

Presenting symptoms and imaging features of posterior cerebral artery stroke causing homonymous hemianopia.
Liu EA, Murali S, Rivera-de Choudens R, Trobe JD.
JOURNAL OF NEURO-OPHTHALMOLOGY
2023;43:393–8.