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A 50 year old woman noticed “something wrong with my vision” over the past several months. The examination is normal apart from these visual fields.

  • Review Topic

    Where is the lesion?

    Incorrect
    Correct!
    This an incomplete left homonymous hemianopia in which the visual field defects have essentially the same extent in both eyes, earning the term “congruous.” Congruity, a term applied only to INCOMPLETE HOMONYMOUS HEMIANOPIAS, reflects the fact that axons derived from corresponding visual field points in the retinas of both eyes have come to lie next to one another and will therefore be harmed together by single lesions. That “neighborliness” of corresponding axons takes place gradually as the optic radiations proceed backwards toward the visual cortex. Thus, the lesion in this patient is likely to lie in the POSTERIOR part of the optic radiations.
  • Of course, it could also lie within the visual cortex (but that was not one of your choices here!).