Optic tract syndrome. A 43-year-old woman suffered a severe closed-head injury from an airplane crash. (A) A complete left homonymous hemianopia is present.

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Optic tract syndrome. A 43-year-old woman suffered a severe closed-head injury from an airplane crash. (A) A complete left homonymous hemianopia is present. This visual field result is said to be nonlocalizing, as it could represent injury anywhere from the right optic tract to occipital cortex. (B) The right optic disc has mild pallor, with loss of nerve fiber striations superiorly and inferiorly. The left optic disc (the eye with the temporal visual field defect) demonstrates “bow-tie” atrophy, with pallor that extends temporally and nasally. A 0.6 log unit (LU) relative afferent pupillary defect (RAPD) is also present in the left eye. The disc pallor and RAPD offer clinical evidence that the site of injury is the right optic tract. (C) The loss of axons originating in the nasal hemiretina (representing the temporal visual field) creates the distinctive bow-tie pattern of pallor. Source: Understanding Visual Field Defects, Practical Neuroophthalmology Citation: Martin TJ, Corbett JJ. Practical Neuroophthalmology; 2013 Available at: https://neurology.mhmedical.com/DownloadImage.aspx?image=/data/books/1041/martin_ch3_fig18.jpeg&sec=59022453&BookID=1041&ChapterSecID=59021898&imagename= Accessed: December 31, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved