A 49-year-old woman, status post temporal lobe resection, reported a hemianopia. Examination revealed a right afferent pupillary defect, horizontal bow-tie atrophy OD (temporal and nasal), and temporal atrophy OS. Optical coherence tomography showed a bow-tie pattern OD and predominant superior and inferior nerve fiber layer loss OS (figure 1; figure e-1 at Neurology.org). The pattern OD is due to the combination of papillomacular bundle and nasal RNFL loss. The pattern OS is due to nerve fiber layer loss temporal to the fovea and, coupled with papillomacular bundle loss, produces temporal pallor.1 MRI confirmed left optic tract atrophy (figure 2). Optical coherence tomography may be sensitive for detecting localizing atrophic patterns.2
OCT = optical coherence tomography; OD = oculus dexter (right eye); OS = oculus sinister (left eye); RNFL = retinal nerve fiber layer.
Atrophy of the left optic tract (arrow) and encephalomalacia of adjacent temporal lobe are seen.
Footnotes
Supplemental data at Neurology.org
Author contributions: Study concept and design: A.J.L.-S., K.N., S.L.G., J.C.R. Acquisition of data: A.J.L.-S., K.N., F.W., J.C.R. Analysis and interpretation: A.J.L.-S., K.N., F.W., J.C.R., S.L.G. Critical revision of the manuscript for important intellectual content: L.J.B., S.L.G., J.C.R. Study supervision: L.J.B., S.L.G., J.C.R.
Study funding: No targeted funding reported.
Disclosure: The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.
- © 2016 American Academy of Neurology
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