Natural history of homonymous hemianopia
Natural history of homonymous hemianopia
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DOI：
10.1212/01.wnl.0000203338.54323.22
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发表时间：
2006-03-28
期刊：
影响因子：
9.9
通讯作者：
Biousse, V
中科院分区：
文献类型：
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作者：
Zhang, X;Kedar, S;Biousse, V
目的：描述同名偏盲(HH)自然恢复的特点。方法：作者回顾了1989-2004年间所有HH患者的医疗记录，这些患者均经正规视野检查确诊，并在服务期间进行了随访。记录临床特征、病因、病变部位的神经放射学定义、最终结果和视野缺陷的演变。分析了最终的视野缺陷结局、受伤时间和临床特征之间的关系。结果：本研究共纳入254例263例高血压病患者。101例(38.4%)术后视野缺陷自发恢复。自发恢复的可能性随着从损伤到初始视野测试时间的增加而降低(p=0.0003)。改善的可能性与受伤后的时间有关(p=0.0003)，在受伤后1个月内测试的患者有50%到60%的改善机会，而在手术后6个月测试的患者下降到约20%。没有发现其他因素与视野缺陷的最终结果相关。受伤后6个月的改善是轻微的，通常与潜在疾病的改善有关。结论：至少50%的患者在受伤后1个月内首次出现同名偏盲的自发改善。在大多数情况下，病情改善发生在受伤后的前3个月内。损伤后6个月的自发改善应谨慎解读，因为这很可能与潜在疾病的改善或患者可靠地进行视野测试的能力的改善有关。
Objective: To describe the characteristics of spontaneous recovery of homonymous hemianopia (HH). Methods: The authors reviewed medical records of all patients with HH confirmed by formal visual field testing and seen in follow-up in their service between 1989 and 2004. Clinical characteristics, causes, neuroradiologic definition of lesion location, final outcome, and evolution of the visual field defects were recorded. The associations among final visual field defect outcome, time from injury, and clinical features were analyzed. Results: A total of 254 patients with 263 HH were included in this study. Spontaneous visual field defect recovery was observed in 101 HH (38.4%). The likelihood of spontaneous recovery decreased with increasing time from injury to initial visual field testing (p = 0.0003). The probability of improvement was related to the time since injury (p = 0.0003) with a 50 to 60% chance of improvement for cases tested within 1 month after injury that decreased to about 20% for cases tested at 6 months after surgery. No other factor was found to correlate with the final outcome of the visual field defects. Improvement after 6 months from injury was mild and usually related to improvement of the underlying disease. Conclusion: Spontaneous improvement of homonymous hemianopia is seen in at least 50% of patients first seen within 1 month of injury. In most cases, the improvement occurs within the first 3 months from injury. Spontaneous improvement after 6 months postinjury should be interpreted with caution as it is most likely related to improvement of the underlying disease or to improvement in the patient's ability to perform visual field testing reliably.