Wednesday, August 6, 2008

Case 10

A 66 years old man with history of hypertension presented to the emergency room with a laceration over the left eyebrow and chin after he hit his head to a door he had not seen. He mentioned that he has a cloudy vision in his right eye.

Last year, he had two episodes of loss of vision in the left eye.

On physical examination, he is afebrile , blood pressure 155/90, pulse 76 /min, respiratory rate 16/min.Cardiovascular exam reveals normal first and second heart sounds, no extra heart sounds, no murmurs, and regular pulse. He had right homonoymous quadrantanopia.the rest of the physical exam is normal

He checked his random cholesterol in a health fair 3 months ago and it was elevated.

1-Locate the intracranial lesion?

2-What extracranial lesion should be ruled out first?


prabodh said...

1.)Left occipital cortex/optic radiations(temporal lobe).
2.)Temporal Arteritis/GCA.

Ranjitha said...

(R) Homonymous Superior or inferior quadrantanopsia could be due to lesions involving optic radiation in either (L) temporal/ parietal lobes respectively.
MCC in an elderly male, with HTN, hyperlipidemia- can be ischemic stroke involving MCA territory.
Previous 2 episodes of (L) eye blindness could be TIA due to occlusion of retinal/ ophthalmic arteries.
Carotid artery stenosis from atheroma needs to be excluded.

kavitha said...

1. lt parietal or temporal region
2. vitreous hemorrhage

Clinical Medicine said...

1-Left parietal lobe.
2-> 70 % left internal carotid stenosis.
The upper fibers of the optic radiation, carrying the visual information from the contralateral lower quadrants, are situated in the parietal lobe. This part of the brain may take its vascular supply from either of the anterior or posterior circulation. Given the history suggestive of the left amaruosis fugax and the occurrence, of the left hemisphere stroke, despite taking aspirin > 70 % internal carotid artery stenosis should be excluded.