Two Patients of Unilateral Compressive Optic Neuropathy and Homonymous Hemianopia After Intracerebral Hemorrhage with Midline Shift

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  • Goto Katsutoshi
    Department of Ophthalmology 1, Kawasaki Medical School
  • Miki Atsushi
    Department of Ophthalmology 1, Kawasaki Medical School Department of Orthoptics, Faculty of Rehabilitation, Kawasaki University of Medical Welfare
  • Yamashita Tsutomu
    Department of Ophthalmology 1, Kawasaki Medical School Department of Orthoptics, Faculty of Rehabilitation, Kawasaki University of Medical Welfare
  • Araki Syunsuke
    Department of Ophthalmology 1, Kawasaki Medical School Doctoral Program in Sensory Science, Graduate School of Health Science and Technology, Kawasaki University of Medical Welfare
  • Mizukawa Kenichi
    Shirai Eye Hospital
  • Ieki Yoshiaki
    Department of Ophthalmology 1, Kawasaki Medical School
  • Kiryu Junichi
    Department of Ophthalmology 1, Kawasaki Medical School
  • Uno Masaaki
    Department of Neurosurgery 1, Kawasaki Medical School

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  • 正中線偏位を伴う脳内出血後に片眼性圧迫性視神経症と同名半盲をきたした2例

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<p>　We present the cases of two patients with unilateral compressive optic neuropathy and homonymous hemianopia following intracranial hemorrhage. Patient 1 was a 43-year-old man. He had aphasia, right hemiplegia, and left conjugate deviation and underwent craniotomy for left putaminal hemorrhage with midline shift on computed tomography. Four months after onset, visual acuity was 1.0 in the right eye and 0.6 in the left. Relative afferent pupillary defect（RAPD）was present in the left eye. Right quadrantanopia was detected by visual field test. Optic nerve atrophy in the left eye was observed. Ganglion cell complex（GCC）thickness on optical coherence tomography was 89.9 μm in the right eye and 73.1μm in the left with thinning around the fovea. Subsequently, GCC thickness in both eyes reduced gradually and progressively in the area, consistent with homonymous hemianopia. Patient 2 was a 72-year-old woman. She had headache, left hemiplegia, disturbance of consciousness and dysarthria and underwent endoscopic hematoma removal for right temporal lobe subcortical hemorrhage with midline shift on magnetic resonance imaging. Three months after onset, visual acuity was 0.2 in the right eye and 0.5 in the left. RAPD was present in the right eye. Optic nerve atrophy in the right eye was observed. GCC thickness was 71.3 μm in the right eye with thinning around the fovea and 94.3μm in the left. In patients with intracerebral hemorrhage with midline shift, direct compression or cerebral edema due to hematoma may cause compression of the intracranial optic nerve, leading to unilateral simple optic atrophy.</p>

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