unilateral quadrantanopia

77-110. (II) Lower altitudinal hemianopia as a result of bilateral destruction of the cunei. 21. It usually affects a Layers 1, 4, and 6 receive crossed fibers; layers 2, 3, and 5 receive uncrossed fibers. Miller, Neil R., Newman, Nancy J. eds. Damage to the left parietal lobe can result in right-left confusion, agraphia and acalculia referred to as Gerstmanns Syndrome. The retinal ganglion cells all meet at the optic nerve head and form the optic nerve[3]. Webhomonymous lower quadrantanopia with macular sparing Vison abnormalities other than visual field deficits can also help localize lesions 1: retina, optic nerve, optic chiasm, or The optic nerve projects from the lamina cribrosa of the scleral canal, through the optic canal, to the optic chiasm. Davis, 1995. pp. Congruity refers to the similarity in shape and depth of the visual field defect in each eye. ), III. C. The superior cervical ganglion projects postganglionic sympathetic fibers through rhe perivascular plexus of the carotid system to the dilator muscle of the iris. (B) Horner's syndrome, left eye. If you find nothing, neuroimaging is essential; place emphasis on the retro-orbital space, the optic nerves, chiasm and optic tracts. The response in the opposite eye is called the consensual pupillary light reflex. According to research, the majority of recovery occurs within the first 60 days after the initial event, and recovery after six months is highly unlikely. Effects of pupillary dilation on automated perimetry in normal patients. McKean-Cowdin R, Wang Y, Wu J, et al. A regular patient to the clinic, he had been seen six months ago for a comprehensive examination and diagnosed with moderate nonproliferative diabetic retinopathy (DR)in both eyes. Biomicroscopy revealed healthy anterior segment structures; dilated funduscopy showed moderate nonproliferative DR, but no evidence of neovascular scaffolding, vitreous hemorrhage or retinal detachment in either eye. This syndrome is most commonly seen in multiple sclerosis. The optic nerve then courses posteriorly until the two optic nerves meet at the chiasm. Visual field testing by confrontation demonstrated severe depression of the superior temporal quadrant of the left eye, but was also noted to affect the superior nasal quadrant of the right eye. quadrantanopia, inferior. Severity of visual field loss and health-related quality of life. Lesions of the Optic Chiasm, Parasellar Region, and Pituitary Fossa. Neurology 2006; 66: pp. A 46-year-old white male complained of blurry vision and a missing spot of vision in his left eye for approximately eight months. Doc Ophthalmol 2003 Nov;107(3):281-7. The pattern of the visual field defect is also more indicative of stroke than other intracranial abnormalities, such as traumatic brain injury, cerebral hemorrhage or compressive tumor. It contains input from the superior retinal quadrants, which represent the inferior visual field quadrants. complaints.Causes of Visual Field Loss. The sufferer is able to detect light within the damaged visual field. WebQuadrantanopia also called quadrantanopsia, refers to a defect in the visual field affecting a quarter of the field of vision. a. Transection causes a contralateral upper quadrantanopia ("pie in the sky")-. At a visit in our clinic several months prior, vision O.S. A. This syndrome consists of miosis, ptosis, apparent enophthalmos, and hemianhidrosis. b. Lesions that involve both cunei cause a lower altitudinal hemianopia (altitud inopia). The nystagmus is in the direction of the large arrowhead. Partial hemianopia means the patient has no visual stimulus in one quadrant of the visual field. A. Dont waste precious minutes before sending the patient for evaluation and care. Frequently seen in females with absent knee or or ankle jerks. 2005 Mar 31.;352(13):1305-16. At the chiasm, the temporal retinal nerve fibers remain uncrossed on the same side and travel ipsilaterally on the optic tract. Natural course of visual field loss in patients with type 2 Usher syndrome. Edgar DF, Crabb DP, Rudnicka AR, et al. The ciliospinal center of Budge (T1-T2) projects preganglionic sympathetic fibers through the sympathetic trunk to the superior cervical ganglion. WebPost-chiasmal lesions result in homonymous field defects, i.e., affecting the same side (right or left) of the visual field and respecting the vertical midline. So macular vision can be spared when only one of the major cerebral vessel distributions is affected. Once confirmed, treatment goals for isolated stroke are aimed at controlling modifiable risk factors that could predispose to subsequent CVAs. This includes tighter control of comorbidities such as diabetes, hypertension, hypercholesterolemia, hyperlipidemia and obesity. A referral to a retinologist, neurologist or internist may be required. If both divisions on one side of the brain are affected, the result is a contralateral homonymous hemianopsia. Imaging for neuro-ophthalmic and orbital disease - a review. In MLF syndrome, or internuclear ophthalmoplegia (see Figure 17-4), there is damage (demyelination) to the MLF between the abducent and oculomotor nuclei. Loss of vision in a quarter of the visual field, Homonymous inferior/superior quadrantanopia, Kolb, B & Whishaw, I.Q. Lesions in the optic tract can also cause an RAPD in certain instances.17. In: Neuro-ophthalmology. Homonymous superior quadrantanopia, also called pie in the sky, causes a field deficit in the superior field of both eyes for the same side. Sparing or involvement of the monocular temporal crescent localizes to the occipital lobe[13]. This enhances subtle pupillary defects. Figure 17-5. E. The lateral geniculate body is a six-layered nucleus. (4) Right hemianopia. Lesions cause contralateral hemianopia with macular sparing. 19. Although it may present as a complete bitemporal hemianopia, most patients will have an asymmetric presentation on visual field testing[4]. [3], Homonymous denotes a condition which affects the same portion of the visual field of each eye. Reproduction in whole or in part without permission is prohibited. CN = cranial nerve. This includes tighter control of comorbidities such as diabetes, hypertension, hypercholesterolemia, hyperlipidemia and obesity. WebQuadrantanopia. 2. J Clin Neurosci 2007 Aug;14(8):754-6. A. At the junction of the optic nerve and the chiasm, there are two different types of fibers on the optic nerve that can be affected: the nasal crossing fibers and the temporal non-crossing fibers. To fully appreciate the potential underlying causes for various visual field defects, it is important to have a working knowledge of the anatomy of the visual system. Clin Ophthalmol. Are there other neurological signs? C. The superior colliculus and pretectal nucleus project to the oculomotor complex of the midbrain. Optic chiasm field defects Lesions at the optic chiasm are characterised by bitemporal hemianopia. (J J) Argyll Robertson pupil. Convergence remains intact. 3. When did you first notice it? Current Opinion in Ophthalmology, 14(6), 325331. If there is . It represents damage to the inferior optic radiating fibers (Meyers loop). (2) Binasal hemianopia. The amount of compensatory movements and the frequency with which they are employed is believed to be dependent on the cognitive demands of the task; when the task is so difficult that the subject's spatial memory is no longer sufficient to keep track of everything, patients are more likely to employ compensatory behavior of biasing their gaze to the afflicted side. At a visit in our clinic several months prior, vision O.S. Has this ever happened before? Visual field recovery after vision restoration therapy (VRT) is independent of eye movements: an eye tracker study. Bilateral lesions can cause complete cortical blindness and can sometimes be accompanied by a condition called Anton-Babinski syndrome. There was a pronounced RAPD in the left eye with reduced color vision (1/14 plates) in the left eye only. Visual outcome of a cohort of children with neurofibromatosis type 1 and optic pathway glioma followed by a pediatric neuron-oncology program. Lastly, the junctional scotoma of Traquair (see Junctional Scotoma and Junctional Scotoma of Traquair) may occur. Ophthalmology 2007 Dec;114(12):2232-7. Stimulation (e.g., from an irritative lesion) causes contralateral deviation of the eyes (i.e., away from the lesion). Vision was 20/30 O.D. 7. b. The medial rectus subnucleus of CN III, which mediates convergence, VI. B. The patient underwent neuroradiological evaluation, and a craniopharyngioma was found. This occurs due to a lesion of the ipsilateral optic nerve, causing an optic neuropathy, and of the contralateral decussating inferior nasal retinal fibers, causing loss of the superior and temporal field in the opposite eye. Wilkins, 1997, p 261. [8] Teaching individuals with quadrantanopia compensatory behaviors could potentially be used to help train patients to re-learn to drive safely. In essence, the more the field loss in one eye appears to be a carbon copy of the other, the greater the level of congruity. Interruption of this pathway at any level causes ipsilateral Horner's syndrome. Kardon R, Kawasaki A, Miller NR. The patient underwent neuroradiological evaluation, and a craniopharyngioma was found. All rights reserved. (1) Ipsilateral blindness. A significant visual field defect was present in not only the left eye, consistent with the patients case history, but also in the right eye. [21] Causes [ edit] J Am Optom Assoc 1995 Nov;66(11):675-80. WebThe location (and frequency) of lesions causing superior quadrantanopias was occipital lobe (83%), parietal lobe (3%), and temporal lobe (13%). Quadrantanopia can be associated with a lesion of optic tract Visual radiation to lingual gyrus Visual radiation to cuneus. 7. 1. The optic chiasm is the point where the two optic nerves meet[3]. 1. Skenduli-Bala E, de Voogd S, Wolfs RC, et al. A value of 80% or less is considered clinically significant. Invest Ophthalmol Vis Sci 2007 Oct;48(10):4445-50. Pelak VS, Dubin M, Whitney E. Homonymous hemianopia: a critical analysis of optical devices, compensatory training, and NovaVision. What is left inferior quadrantanopia? Quickly switch the occluder to the normal eye, and shine the light in the abnormal eye. Light shincd into one eye causes both pupils to constrict. 9. [1] While quadrantanopia can be caused by lesions in the temporal and parietal lobes of the brain, it Less commonly, the uncrossed temporal fibers are compressed, manifesting with a monocular nasal field defect in the ipsilateral eye. The rostral Edinger-Westphal nucleus, which mediates pupillary constriction through the ciliary ganglion. Nerve fibers originating in the nasal retina cross at the level of the optic chiasm, traveling with contralateral temporal fibers to the lateral geniculate nucleus where they synapse. Compressive Lesions of the Optic Chiasm: Subjective Symptoms and Visual Field Diagnostic Criteria. It projects to the ipsilateral lateral rectus muscle and, through the medial longitudinal fasciculus (MLF), to the contralateral medial rectus subnucleus of the oculomotor complex. Parietal lobe lesion (infarct, hemorrhagic stroke, trauma)on the side opposite the visual field defect. His visual acuity recovered fully, but his visual fields only partially recovered. It can be associated with a lesion of an optic radiation. Occlude the abnormal eye and shine the light in the normal eye. Neuro-Ophthalmology (Amsterdam: Aeolus Press. Recovery from poststroke visual impairment: evidence from a clinical trials resource. Any complaint of headaches not explained by the exam. Kardon RH, Thompson HS. 18. History of head trauma. Meschia JF, Bushnell C, Boden-Albala B, et al. Webfingers appropriately, this can be scored as normal. [5], A lesion affecting one side of the temporal lobe may cause damage to the inferior optic radiations (known as the temporal pathway or Meyer's loop) which can lead to superior quadrantanopia on the contralateral side of both eyes (colloquially referred to as "pie in the sky"); if the superior optic radiations (parietal pathway) are lesioned, the visual loss occurs on the inferior contralateral side of both eyes and is referred to as an inferior quadrantanopia. THE VISUAL PATHWAY (Figure 17-1) includes the following structures. 2. They project from the nasal hemiretina to the contralateral lateral geniculate body and from the temporal hemiretina to the ipsilateral lateral geniculate body. Premature Ejaculation Causes and Treatment, Anxiety and Panic Disorders Holistic Cure, Electromagnetic Radiation and Human Health, How to Improve Your Sex Life With Your Partner. Lesion A of visual radiations to sup. Superior right quadrantanopia. 1. and 20/80 O.S. Clin Exp Ophthalmol. If patient is blind from any cause, score 3. Remember: Nearly half of the nerve fibers cross at the optic chiasm, so the loss of visual field on one side is quite different than loss of vision in one eye. Spencer EL, Harding GF. C. Argyll Robertson pupil (pupillary light-near dissociation) is the absence of a miotic reaction to light, both direct and consensual, with the preservation of a miotic reaction to near stimulus (accommodation-convergence). Bilateral deficits are caused by chiasmal lesions or lesions affecting the retrochiasmal pathways. Post-geniculate fibers split into superior and inferior pathways, traveling through the parietal and temporal lobes, respectively, as they course posteriorly in the brain. Note that half of the optic nerves cross at the optic chiasm, causing vision loss on one side to be quite different than that in one eye. Consultation with the appropriate medical caregiver is prudent. O.S. Kudrna GR, Stanley MA, Remington LA. 909917.e1). The etiologies of retrochiasmal lesions are different between adults and children. Am J Ophthalmol. O.S. It contains noncrossing fibers from the two temporal hemiretinas and projects fibers to the suprachiasmatic nucleus of the hypothalamus. Definition (NCI) Blurred vision is the loss of visual acuity (sharpness of vision) resulting in a loss of ability to see small details. McKean-Cowdin R, Varma R, Wu J, et al. Contralateral homonymous superior quadrantanopia often called pie in the sky is seen when a mass lesion is in the temporal lobe. Sign or Symptom ( T184 ) SnomedCT. E. Relative afferent (Marcus Gunn) pupil results from a lesion of the optic nerve, the afferent limb of the pupillary light reflex (e.g., retrobulbar neuritis seen in multiple sclerosis). 2. We learned this principle from professor Lou Catania, OD, quoting Hickams dictum: The patient may have as many diseases as he or she pleases.. Connections of the pontine center tor lateral conjugate gaze. All rights reserved. had been recorded at 20/25. Optic nerve sheath meningioma. Transection of the lower division (B) results in right upper homonymous quadrantanopia. It also involves the occipital lobe concerned with vision. It also receives fibers from the ipsilateral temporal hemiretina and the contralateral nasal hemiretina. Impact of visual field loss in health-related quality of life in glaucoma: the Los Angeles Latino Eye Study. Orbital masses. Kedar S, Zhang X, Lynn MJ, et al. He was alert and oriented, had a normal gait and displayed no affective abnormalities. This is considered a bitemporal visual field defect despite the extension into the superior nasal quadrant in the left field. Sudden unilateral quadrantanopia caused by retinal diseases often has characteristic presentations, such as acute onset and severe visual acuity defect. As we know, purely unilateral field defects typically reflect pre-chiasmal lesions, either within the retina or optic nerve. INTRODUCTION. Arch Ophthalmol 2001 Dec;119(12):1788-94. Retina 2007 Jun;27(5):601-8. 4. WebA superior quadrantanopia results from an insult to the optic radiation inferiorly in the temporal lobe, resulting in a pie in the sky type of visual field defect (Figure 1d), while an One study found a five-fold increase of visual field loss between ages 55 and 80. Association of visual field loss and mobility performance in older adults: Salisbury Eye Evaluation Study. It includes the following structures: A. Lebers hereditary optic neuropathy with childhood onset. left, O.D. Examining visual field defects in the paedriatric population exposed to vigabatrin. (F) Paralysis of upward gaze and convergence (Parinauds syndrome). The pupil. Post-chiasmal lesions result in homonymous field defects, i.e., affecting the same side (right or left) of the visual field and respecting the vertical midline. What does the rest of the ocular examination reveal? Occasionally, patients will spontaneously recover vision in the affected field within the first three months after the brain injury; however, vision loss remaining after this period of spontaneous recovery is traditionally thought to be permanent, certain companies now claim to be able to induce recovery of vision after this three-month period. (C) Internuclear ophthalmoplegia, right eye. Scotomas that change can be considered transient, so they are more likely vascular in origin. [1] While quadrantanopia can be caused by lesions in the temporal and parietal lobes of the brain, it is most commonly associated with lesions in the occipital lobe. 15. CN = cranial nerve. The patient was advised that he had likely suffered an isolated stroke which caused him to experience vision loss. Automated perimetry (e.g., Humphrey Visual Field (10-2, 24-2, and 30-2)) is recommended for all patients with unexplained visual loss. 11. Total monocular field loss. One study demonstrates congruous visual field defects encountered in 350% of lesions to the optic tract or optic radiations, although 84% of occipital lobe lesions produced congruous field defects.2 Also, the vast majority of incongruous visual field defects occur with lesions to the optic radiations, which are located more anteriorly.2 One important caveat to this rule is that only incomplete homonymous hemianopias may be described as congruous or incongruous. Common and/or Classic Visual Field Patterns and Their Causes Glaucoma and mobility performance: the Salisbury Eye Evaluation Project. Optic tract lesions are relatively uncommon[9], with lateral geniculate nucleus (LGN) lesions being even more rare but when seen, are due to ischemic, demyelinating, or traumatic etiologies. D. The ciliary ganglion, which gives rise to postganglionic parasympathetic fibers. Nerve fibers originating in the nasal retina cross at the level of the optic chiasm, traveling with contralateral temporal fibers to the lateral geniculate nucleus where they synapse. The junctional scotoma (see Junctional Scotoma and Junctional Scotoma of Traquair) manifests as a central scotoma in the ipsilateral eye and a superior temporal visual field defect in the contralateral eye. Specific visual field deficits can be attributed to the location of compression, which in turn can help clinicians localize lesions based on physical examination and diagnostic testing. Any other clinical finding (subjective or objective) that does not correlate with other examination findings.In many cases, attention to proper hydration and caloric intake, along with awareness of the effects of postural changes (e.g., standing up quickly from a seated or reclined position) is sufficient for managing the symptoms. Clinicians should be aware of the localizing value of specific visual field defects and perform neuroimaging to exclude a structural lesion including mass lesions[15]. 20. WebRed Eye, Red Herring A 49-year-old Hispanic male presented with complaints of a red, irritated left eye with significantly reduced vision in the same eye. Lesions of the occipital lobe result in homonymous hemianopias, contralateral to the side of the lesion (i.e., a right-sided field defect with a left-sided lesion and vice-versa). Transection of the upper division (A) results in right lower homonymous quadrantanopia. Visual field manifestations can be variable within the orbit, depending on the location of compression and the fibers affected. Ask the patient to assign a brightness value of 100 points to that light. 2. Due to the abrupt onset of symptoms, we suspected a cerebrovascular accident affecting the posterior optic radiations or anterior occipital cortex. The difference between partial hemianopia and complete hemianopia is how much of a patients visual field is affected. Understand that the presence of anisocoria doesnt create a clinically observable pseudo-APD until anisocoria of 2mm or more is present.19 So, dont dismiss subtle or trace RAPD responses to a 0.5mm anisocoria. Inferiorquadrantanopia. J Amer Geriatr Soc 2007 Mar;55(3):357-64. Another way to help confirm subtle RAPDs is to purchase an inexpensive 0.3 log unit neutral density (ND) filter. If patient is blind from any cause, score 3. To understand these field defects, its necessary to know how the eye processes the visual field. Damage to the optic radiations De Moraes, C. G. (2013). The anterior area receives monocular input. Smoking cessation (including avoidance of second-hand smoke), a low-fat diet and regular exercise are also typically encouraged. This lesion causes ipsilateral blindness and a contralateral upper temporal quadrant defect (junction scotoma). The upper division (Figure 17-2) projects to the upper bank of the calcarine sulcus, the cuneus. The posterior area receives macular input (central vision). Figure 17-1. If there is extinction, patient receives a 1, and the results are used to respond to 249-252, Wen PY, and Kesari S: Malignant gliomas in adults. With inferior parietal lesions, quadrantanopia involves the lower quadrants of the field, with the side of the quadrant loss depending on the laterality of the lesion. Retinitis pigmentosa. Vision restorative training (VRT) may provide a mechanism to regain visual function at the border of the visual field defect, although studies with this system have yielded conflicting and inconclusive results. Stimulation causes contralateral conjugate deviation of the eyes. This is considered a bitemporal visual field defect despite the extension into the superior nasal quadrant in the left field.How quickly does the referral need to be made? 13. Recurrent and transient holes in the visual field may indicate a vascular perfusion deficit. Ultimately, this patient was diagnosed with neurosyphilis, and was treated with penicillin. Knowledge of the functional anatomy of neurological pathways is essential in the interpretation of examination results. The temporal retinal processes the nasal visual field, while the nasal retina processes the temporal visual field. 14. Nearly one out of every 20 people past age 55 has visual field loss that is significant enough to impair daily functioning.1 Difficulties experienced by these patients include a higher risk of falling, reduction in physical mobility, disability, diminished quality of life, and diminished ability to watch television or read.1-7 The incidence of visual field loss increases with age. The areas of the field lost in each eye are shown as black areas. Chimowitz MI, Lynn MJ, Howlett-Smith H, et al. The cuneus is the upper bank. Bilateral constricted fields may be seen in hysteria. Color vision, visual fields and extraocular motilities were normal in both eyes. [citation needed], The prospects of recovering vision in the affected field are bleak. Arch Ophthalmol 2005 Feb;123(2):233-8. The frontal eye field is located in the posterior part of the middle frontal gyrus (Brodmann's area 8). Any complaint of a fixed missing spot in the visual field (monocular or binocular). When patients display other neurological symptoms, an immediate referral is required. The associated features like aphasia and hallucinations will help to further localize lesions to the temporal lobe[13]. If you can confirm that the visual field is not organic in nature, careful consideration for a referral to a psychologist or psychiatrist is indicated. Binocular visual-field loss increases the risk of future falls in older white women. If there is extinction, patient receives a 1, and the results are used to respond to However, other field defects, like a junctional scotoma or a junctional scotoma of Traquair, may occur[14]. In (eds): Neurologic Complications of Cancer. 3. Ophthalmology 2006 Aug;113(8):1345-53. This review discusses conditions (other than glaucoma) that can cause symptomatic visual field loss, and it includes a practical guide to ancillary testing and referral of these patients. Lesions of the occipital lobe will result in contralateral congruous homonymous hemianopia. 1. Time is critical! Coleman AL, Cummings SR, Yu F, et al. WebThe syndrome of visuospatial neglect is a common consequence of unilateral brain injury. It regulates voluntary (saccadic) eye movements. Hypothalamic neurons of the paraventricular nucleus project directly to the ciliospinal center (T1-T2) of the intermediolateral cell column of the spinal cord. The decision to order radiological testing or wait for the neurologist to do it will also vary, depending upon your working relationship with the neurologist and the imaging centers in your area. Ed: Rosen ES, Eustace P, Thompson HS, et al. The visual field defect seen in the chiasmal syndrome is typically a bitemporal hemianopsia. B. One-and-a-half syndrome consists of bilateral lesions of the MLF and a unilateral le* sion of the abducent nucleus. 2. WebHomonymous hemianopia is a visual field defect involving either the two right or the two left halves of the visual fields of both eyes. HVr6}WX0. Headache and photophobia have also been known symptoms[4]. So, if the patient says, I cant see on the left side, you need more clarification before you develop a short list of differential diagnoses. (7) Right hemianopia with macular sparing. Quadrantanopia can also result in significant constraints of ones vision and ability to The History Makes the Diagnosis A Cellulite Cure - How to Get Rid of Cellulite. This visual field defect is characteristic of damage to Meyer's loop on the left side of the brain. Reproduction in whole or in part without permission is prohibited. (G) Fourth-nerve palsy, right eye. Baltimore, Williams &. Common cause(s) A. Ganglion cells of the retina form the optic nerve [cranial nerve (CN) II]. CORTICAL AND SUBCORTICAL CENTERS FOR OCULAR MOTILITY. J AAPOS 2006; 10: pp. II. [6], Binasal (either inferior or superior) quadrantanopia affects either the upper or lower inner visual quadrants closer to the nasal cavity in both eyes. Journal of Glaucoma, 22 Suppl 5 Suppl 1, Proceedings of the 18th Annual Optic Nerve Rescue and Restoration Think Tank: Glaucoma and the Central Nervous System September 1617, 2011 New York, NY Sponsored by The Glaucoma Foundation (TGF), S2S7. 1. A fixed and dilated pupil, ptosis, and a "down-and-out" eye are caused by pressure on the ipsilateral oculomotor nerve. The underlying diagnosis is often serious and can threaten long-term vision and even the patients well-being. 10. A trace relative afferent pupillary defect was seen O.S., but both pupils were of normal size. 530 Walnut Street, Philadelphia, Pennsylvania 19106 USA; 351 West Camden Street, Baltimore, Maryland 21201-2436 USA:Lippincott Williams & Wilkins; 2005. Webunilateral blindness or enucleation, visual fields in the remaining eye are scored. 1. Partial vs. complete hemianopia. The monocular temporal crescent is represented in the most anterior mesial portion of the occipital lobe. left, O.D. The hypothalamus. Barton JJS. O.S. Bitemporal (either inferior or superior) quadrantanopia affects either the upper or lower outer visual quadrants in both eyes. https://doi.org/10.1097/00055735-200312000-00002, Lee AG, Johnson MC, Policeni BA, Smoker WR. Townend BS, Sturm JW, Petsoglou C, et al. Otherwise, many of these cases are considered to be urgencies rather than emergencies, and require referral within a few days to a week. WebIt can be caused by a lesion, particularly, in the temporal and parietal lobes although it is more commonly associated with occipital lobe lesions. &#xK:KYRd#:2{D~T_sdrSM"7n|(rPG7C=7>W +U endstream endobj 55 0 obj <> endobj 56 0 obj <> endobj 57 0 obj <> endobj 58 0 obj [/ICCBased 89 0 R] endobj 59 0 obj <> endobj 60 0 obj <> endobj 61 0 obj <> endobj 62 0 obj <> endobj 63 0 obj <> endobj 64 0 obj <> endobj 65 0 obj <>stream

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