Further Diagnostic Workup
Automated perimetry for the right eye (Figure 1) revealed a large number of fixation losses and low test reliability with decreased sensitivity in both hemifields. The left eye (Figure 2) showed more decreased sensitivity in the temporal field.
Figure 1. Automated perimetry of the right eye shows decreased sensitivity in both hemifields.
Figure 2. Automated perimetry of the left eye shows decreased sensitivity in both hemifields but more so in the temporal field.
Diagnostic Question
On the basis of the study results, what is your working diagnosis now?
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The visual field defect is most suggestive of an incomplete right homonymous hemianopia.
Diagnostic Question
What would confirm the diagnosis?
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MRI of the brain should help reveal the cause of the visual field defect (Figure 3).
Figure 3. Fluid-attenuated inversion recovery MRI of the brain shows a lesion in the left parieto-occipital cortex.
MRI of the brain revealed a large left parieto-occipital lesion with characteristics suggestive of an arteriovenous malformation (AVM).
Diagnostic Question
What additional workup is recommended?
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A neurosurgical evaluation is suggested.