急性孤立性枕叶脑梗死患者治疗前后的视野缺损

Abstract

Objective

Toobservethechangesinvisualfielddefectbeforeandaftertreatmentinpatientswithacutesolitaryoccipitallobecerebralinfarction.

Methods

FromJanuary2017toMay2019,59patientswithhemianopsiawhowerediagnosedasacuteoccipitallobecerebralinfarctioninHenanProvincialPeople'sHospitalwereselected.Therewere35males(59.3%)and24females(40.7%);agedfrom50to72years,withanaverageageof62.86±6.10years.Therewere23patientsofrightoccipitalcerebralinfarctionand36patientsofleftoccipitalcerebralinfarction.Lesionsinvolved41patientsinthestriatedarea,8patientsinvolvedtheoccipitalpole,and23patientsinvolvedvisualradiation.Allpatientsunderwentstandardmedicaltreatment.Allpatientsunderwentvisualfieldexaminationbeforetreatment,andmodifiedrankinscale(mRS)wasusedtoevaluatethelevelofvisualdisabilityaftercerebralinfarction.At1,3,and6monthsaftertreatment,54patientsunderwentatleastonevisualfieldexaminationinoutpatientorinpatientfollow-upvisits,and5patientswerelosttofollow-up;49patientsreceivedrepeatedmRSscores.ThevisualfielddefectandmRSscoreofpatientsbeforeandaftertreatmentwerecomparedandanalyzed.Theimprovementofvisualfielddefectinthehorizontaldirectionexceeding10°ortheverticaldirectionexceeding15°wasdefinedasimprovement,otherwiseitwasdefinedasnoimprovement.Accordingtothetypeofvisualfielddefect,thepatientsweredividedintotwogroups:completehomonymoushemianopiaandincompletehomonymoushemianopia.Thecumulativevisualfieldimprovementrateofthetwogroupsofpatientswascalculated.AnmRSscoreof0to2wasdefinedasagoodprognosis,and>2wasdefinedasapoorprognosis.

Results

Beforetreatment,ofthe59patients,47werecompletehomonymoushemianopsiaand12wereincomplete.Ofthe47patientswithcompletehomonymoushemianopia,26patientshadhemianopiaontherightsideofbotheyes,21patientshadhemianopiaontheleftsideofbotheyes;32patientswithmacularavoidance(72.3%).Amongthe12patientsofincompletehomonymoushemianopia,10patientsofquadrantblindnessincluded6patientsofupperquadrantand4patientsoflowerquadrant;2patientsofpartialisotropichemianopiaononeside.Ofthe54patientsreviewedaftertreatment,thevisualfieldimprovedatthelastfollow-upof25patients(46.3%),andtherewasnoimprovementin29patients(53.7%).Thecumulativevisualfieldimprovementrateof47patientswithcompletehemianopiahemianopiabeforetreatmentwas37.2%(16/43).Thecumulativevisualfieldimprovementrateof11patientswithincompleteisotropichemianopiabeforetreatmentwas81.8%(9/11).Therewasastatisticallysignificantdifferenceincumulativevisualfieldimprovementbetweenthetwogroupsofpatients(χ2=7.011,P<0.05).Beforetreatment,59patientshadmRSscoresof1to2pointsin15patients(25.4%),and44patientswith2pointsormore(74.6%).Ofthe49patientsreviewedaftertreatment,28(57.1%)hadagoodprognosisand21(42.9%)hadapoorprognosis.

Conclusions

Thevisualfielddefectofpatientswithhomonymoushemianopsiaafteracuteoccipitalinfarctionmaybeimprovedaftertreatment.Theimprovementmostlyoccurswithin1maftertreatment,andpatientswithincompletehomonymoushemianopsiahavemoresignificantimprovementsthanthosewithcompletehomonymoushemianopsia.

Keywords:

Occipitallobe;Cerebralinfarction;Visualfields;Hemianopsia