An atypical presentation of functional visual loss
| Autor: | Junkyu Chung, Kyung Hyun Jin, Tae Gi Kim, Jaheon Kang |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Visual acuity genetic structures Homonymous hemianopsia Visual Acuity Optic chiasm Diagnosis Differential 03 medical and health sciences 0302 clinical medicine Ophthalmology medicine Humans Clinical Case Report functional visual loss Conversion disorder Hemianopsia Cognitive Behavioral Therapy medicine.diagnostic_test business.industry Binasal hemianopsia Accidents Traffic Brain General Medicine Middle Aged homonymous hemianopsia medicine.disease Magnetic Resonance Imaging eye diseases Visual field Treatment Outcome medicine.anatomical_structure binasal hemianopsia Visual field test 030221 ophthalmology & optometry Visual Field Tests medicine.symptom Tomography X-Ray Computed business Stress Psychological 030217 neurology & neurosurgery Research Article |
| Zdroj: | Medicine |
| ISSN: | 0025-7974 |
| Popis: | Rationale: Functional visual loss (FVL) can manifest as various symptoms. Decreased distant visual acuity is the most common symptom and visual field defect is the second most common symptom. Hemianopsia is rarely reported. In an atypical situation of FVL, it is important to prove that no organic pathology exists, through detailed history taking and appropriate examinations. Patient concerns: This review presents the case of a 48-year-old male patient presented with decreased bilateral visual acuity and visual field defect after a traffic accident 3 weeks ago. Visual field test showed atypical features of FVL in which visual field change from binasal hemianopsia to left homonymous hemianopsia. Diagnosis: The best corrected visual acuities (BCVA) were 20/63 in both eyes and binasal hemianopsia was observed on a Humphrey visual field test. Brain computed tomography (CT) scan and magnetic resonance imaging (MRI) showed no abnormalities in the brain and optic chiasm. Two weeks after presentation, however, the patient's visual field defect changed from binasal hemianopsia to left homonymous hemianopsia. We diagnosed it as FVL due to conversion disorder. Intervention and outcomes: We decided to cooperate with a psychiatrist for cognitive behavioral therapy and the patient is under observation. Lessons: Binasal hemianopsia and homonymous hemianopsia are rare; however, it may occur simultaneously in 1 patient with FVL. The possibility of FVL should be considered when there is atypical visual field defect and no organic abnormalities are observed. Repeated Humphrey field test and VEP may be helpful in diagnosis of FVL. |
| Databáze: | OpenAIRE |
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