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In Vivo Demonstration of Homonymous Hemimacular Loss of Retinal Ganglion Cells Due to a Thalamic Lesion Using Optical Coherence Tomography

Jiwon Oh, MD; Elias S. Sotirchos, MD; Shiv Saidha, MBBCh, MRCPI; Mohamed Ibrahim, MD; Yasir Sepah, MD; Quan Dong Nguyen, MD; Peter A. Calabresi, MD
JAMA Neurol. 2013;70(3):410-411. doi:10.1001/jamaneurol.2013.605.
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A previously healthy 40-year-old woman presented with subacute onset of a left homonymous hemianopia. Contrast-enhanced magnetic resonance imaging of the brain revealed a T2-hyperintense lesion in the right thalamus, with associated subtle gadolinium enhancement (Figure 1), and a small periventricular lesion. Although her visual symptoms were improving, a new left-sided hemiparesis developed 3 weeks later. Additional magnetic resonance imaging of the brain showed extension of the original thalamic lesion into the right internal capsule, with persistent contrast enhancement. Her visual and motor symptoms gradually improved over 3 months.

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Figure 1. A, Axial fluid-attenuated inversion recovery sequence on magnetic resonance imaging showing a hyperintense lesion (arrow) in the right lateral thalamus. The T1-weighted sequence before (B) and after (C) the administration of gadolinium contrast medium shows corresponding subtle contrast enhancement within the lesion (arrows).

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Figure 2. A and B, Scanning laser ophthalmoscope microperimetry map (OPKO Health Inc) demonstrating a homonymous hemianopic visual field deficit. The color-coded visual attenuation scale provides the mean retinal sensitivity to a standardized visual stimulus (range, 0-20 dB; with 0 representing the absence of retinal sensitivity and 20 representing maximum retinal sensitivity). C and D, Cirrus high-definition–optical coherence tomographic macular thickness maps (in units of micrometers) demonstrate hemimacular thinning, which corresponds to the demonstrated visual field deficit (green = 5%-95%, yellow = 1%-5%, and red = less than 1% for age-matched controls).

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