両側後頭葉の脳梗塞により黄斑回避のある両側同名半盲をきたした1例

Homonymous right and left hemianopia with macular sparing in a case of bilateral occipital infarction

要約　目的：両側の後頭葉脳梗塞で，両側の同名半盲が生じた症例の報告。症例：70歳男性に右視野欠損が生じ，脳外科で左後頭葉梗塞が発見され，紹介され受診した。5年前から高血圧で加療中であった。所見：視力を含む一般眼科検査では異常がなく，視野検査で黄斑回避を伴う右同名半盲があった。30か月後に急激な両眼の視朦と頭重感があり，右後頭葉梗塞が発見された。内頸動脈の狭窄はなかった。矯正視力は左右眼とも1.0で，固視点を含む縦の帯状部のみを残す左右の同名半盲があった。以後7年間，ほぼ同じ状態を維持しているが，視野には改善がない。結論：左後頭葉梗塞に続発した右後頭葉梗塞で，右側の同名半盲に左側の同名半盲が加わり，固視点を含む縦の帯状部のみが残る視野欠損が生じた。

Abstract.　Purpose：To report a case of bilateral homonymous hemianopia secondary to bilateral occipital infarction. Case：A 70-year-old male noticed sudden loss of right visual field. He was referred to us after detection of left occipital lobe infarction. He had been treated for systemic hypertension since 5 years before. Findings：Routine ophthalmological findings were within normal limits. Goldmann perimetry showed right homonymous hemianopia with macular sparing. The patient noticed sudden blurring of vision with headache 30 months later,leading to the detection of right occipital lobe infarction. No attenuation was present in the internal carotid arteries. Visual acuity was 1.0 in either eye. Perimetry showed combination of homonymous right and left hemianopia with macular sparing,or visual field loss except the vertical zone including the point of fixation in both eyes. Conclusion：Bilateral occipital infarction resulted in bilateral homonymous hemianopia with macular sparing.