Assessment of Visual Dysfunction in a Patient with Right Occipital Infarct

右枕葉腦梗塞病患之視覺評估

蔡麗婷(Li-Ting Tsai) ； 蘇裕欽(Yu-Chin Su) ； William H.A. Beaudot ； 楊韻祥(Yun-Hsiang Yang)

《台灣復健醫學雜誌》 43卷3期 (2015/09) Pp. 191-200

https://doi.org/10.6315/2015.43(3)06

摘要

目的：評量一位右枕葉腦梗塞的病患，在初階和高階視覺功能之視覺狀況。枕葉是大腦皮質最早接收和處理視覺訊息的區域，枕葉損傷可能造成視野問題之外，還可能影響其他的視覺功能。但是過去少有文獻探討這樣的案例。個案報告：一位54歲的女性病患漸進式的右側枕部頭痛兩週。有視力模糊及左半側偏盲情形。腦部磁振攝影發現右後大腦動脈區域有梗塞，而且主要在右枕葉部位。故予安排進一步的基本及高階視覺功能檢查評估，來確認她的視覺問題。進行多項的視覺功能評估後，確認個案除了視野問題之外，在基本視覺功能方面，同時有視力、色知覺、對比知覺和立體視覺之問題。在視覺注意力部分，個案在分散式注意力和選擇式注意力的表現，顯著低於其他正常受試者。此部分除受到視野的影響之外，還有其他的影響因素，特別在選擇式注意力項目。結論：從此病患的臨床表現可發現，視野缺損無法完整呈現枕葉腦中風的視覺功能或具功能性的視覺能力。視力，色覺，對比敏感度，立體視覺以及視覺注意力都跟視皮質有關。從視覺復健的觀點，對枕葉中風患者做全面性的視覺功能評估，對後續視覺復健計畫的擬定是非常必要的。

關鍵字

缺血性腦中風 ； 枕葉 ； 視覺功能 ； 視覺障礙 ； 視覺復健

並列摘要

Purpose: This study describes a patient with multiple visual impairments following right occipital infarction in the posterior cerebral artery (PCA) territory. The earliest stage of cortical processing of visual information occurs in the occipital lobe, so damage to this lobe causes not only visual field deficits but also other forms of visual problems. However, few cases of this sort have previously been reported in the literature. Case report: A 54-year-old female suffered from a progressive throbbing headache over the right occipital area for 2 weeks. Blurred vision and left hemianopia were found, and brain magnetic resonance imaging revealed cerebral infarction over the right posterior cerebral artery territory, mainly over the right occipital lobe. Advanced assessment in basic and high levels of visual function was arranged to confirm her visual complaints. Several types of assessment of visual function revealed not only visual field defects but also impairments in visual acuity, color vision, contrast sensitivity function, and stereo vision. In addition, deficits in visual attention test were also observed, mainly in divided and selective attention, which cannot only be explained by impaired visual deficits. Conclusion: In this case, defining visual impairment by visual fields did not present the whole impact of occipital stroke on the visual function and functional vision. Deficits in visual acuity, color vision, contrast sensitivity, stereo acuity, and visual attention were associated with visual cortex lesion. In terms of visual rehabilitation, there is a need for comprehensive visual assessment of patients with occipital stroke.

並列關鍵字

ischemic stroke ； occipital lobe ； visual function ； visual impairment ； visual rehabilitation

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