Ischemic Stroke and Homonymous Visual Field Defects

  • Ondřej VolnýEmail author
  • Michal Haršány
  • Robert Mikulík


Cerebrovascular diseases are major causes of morbidity and mortality in developed and developing countries. The major burden of cerebrovascular diseases is due to long-term disability and economy losses. In this chapter, we describe basic epidemiology, etiology, management, treatment (intravenous thrombolysis and mechanical thrombectomy), and secondary prevention of ischemic stroke. Special emphasis is put on ischemic strokes in the territory of posterior cerebral artery, which represent 5–10% of all ischemic strokes. Over 90% of the patients have visual field defects. The most frequent type of visual field defect is represented by homonymous hemianopsia occurring in about three-quarters of the patients with occlusions of posterior cerebral artery.


Ischemic stroke Posterior cerebral artery Intravenous thrombolysis Mechanical thrombectomy 



Ondřej Volný, Michal Haršány and Robert Mikulík are supported by project no. LQ1605, National Program of Sustainability II.


  1. 1.
    Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet. 2006;367(9524):1747–57.CrossRefPubMedGoogle Scholar
  2. 2.
    Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, et al. Global and regional burden of stroke during 1990-2010: findings from the global burden of disease study 2010. Lancet. 2014;383(9913):245–54.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Menken M, Munsat TL, Toole JF. The global burden of disease study: implications for neurology. Arch Neurol. 2000;57(3):418–20.CrossRefPubMedGoogle Scholar
  4. 4.
    Astrup J, Siesjo BK, Symon L. Thresholds in cerebral ischemia – the ischemic penumbra. Stroke. 1981;12(6):723–5.CrossRefPubMedGoogle Scholar
  5. 5.
    Menon BK, Smith EE, Modi J, Patel SK, Bhatia R, Watson TW, et al. Regional leptomeningeal score on ct angiography predicts clinical and imaging outcomes in patients with acute anterior circulation occlusions. AJNR Am J Neuroradiol. 2011;32(9):1640–5.CrossRefPubMedGoogle Scholar
  6. 6.
    Lees KR, Bluhmki E, von Kummer R, Brott TG, Toni D, Grotta JC, et al. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet. 2010;375(9727):1695–703.CrossRefPubMedGoogle Scholar
  7. 7.
    Mazighi M, Serfaty JM, Labreuche J, Laissy JP, Meseguer E, Lavallée PC, et al.; RECANALISE investigators. Comparison of intravenous alteplase with a combined intravenous-endovascular approach in patients with stroke and confirmed arterial occlusion (RECANALISE study): a prospective cohort study. Lancet Neurol. 2009;8(9):802–9.Google Scholar
  8. 8.
    Saver JL, Goyal M, Diener HC, SWIFT PRIME Investigators. Stent-retriever thrombectomy for stroke. N Engl J Med. 2015;373(11):1077.PubMedGoogle Scholar
  9. 9.
    Goyal M, Demchuk AM, Hill MD. Endovascular therapy for ischemic stroke. N Engl J Med. 2015;372(24):2366.CrossRefPubMedGoogle Scholar
  10. 10.
    Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, et a1; REVASCAT Trial Investigators. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372(24):2296–306.Google Scholar
  11. 11.
    Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, et al.; SWIFT PRIME Investigators. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015;372(24):2285–95.Google Scholar
  12. 12.
    Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al.; ESCAPE Trial Investigators. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372(11):1019–30.Google Scholar
  13. 13.
    Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, et al.; MR CLEAN Investigators. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372(1):11–20.Google Scholar
  14. 14.
    Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, et al.; EXTEND-IA Investigators. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372(11):1009–18.Google Scholar
  15. 15.
    Wahlgren N, Moreira T, Michel P, Steiner T, Jansen O, Cognard C, et al. Mechanical thrombectomy in acute ischemic stroke: consensus statement by ESO-Karolinska stroke update 2014/2015, supported by ESO, ESMINT, ESNR and EAN. Int J Stroke. 2016;11(1):134–47.CrossRefPubMedGoogle Scholar
  16. 16.
    Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC, et al. 2015 American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46(10):3020–35.CrossRefPubMedGoogle Scholar
  17. 17.
    Pexman JH, Barber PA, Hill MD, Sevick RJ, Demchuk AM, Hudon ME, et al. Use of the alberta stroke program early CT score (ASPECTS) for assessing CT scans in patients with acute stroke. AJNR Am J Neuroradiol. 2001;22(8):1534–42.PubMedGoogle Scholar
  18. 18.
    Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, et al.; RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361(12):1139–51.Google Scholar
  19. 19.
    Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, et al.; ROCKET AF Investigators. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365(10):883–91.Google Scholar
  20. 20.
    Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, et al.; ARISTOTLE Committees and Investigators. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365(11):981–92.Google Scholar
  21. 21.
    Pessin MS, Lathi ES, Cohen MB, Kwan ES, Hedges TR, Caplan LR. Clinical features and mechanism of occipital infarction. Ann Neurol. 1987;21(3):290–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Cals N, Devuyst G, Afsar N, Karapanayiotides T, Bogousslavsky J. Pure superficial posterior cerebral artery territory infarction in the lausanne stroke registry. J Neurol. 2002;249(7):855–61.CrossRefPubMedGoogle Scholar
  23. 23.
    Kumral E, Bayulkem G, Ataç C, Alper Y. Spectrum of superficial posterior cerebral artery territory infarcts. Eur J Neurol. 2004;11(4):237–46.CrossRefPubMedGoogle Scholar
  24. 24.
    Lister WT, Holmes G. Disturbances of vision from cerebral lesions, with special reference to the cortical representation of the macula. Proc R Soc Med. 1916;9(Sect Ophthalmol):57–96.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Ogawa K, Ishikawa H, Suzuki Y, Oishi M, Kamei S. Clinical study of the visual field defects caused by occipital lobe lesions. Cerebrovasc Dis. 2014;37(2):102–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Brindley GS, Janota I. Observations on cortical blindness and on vascular lesions that cause loss of recent memory. J Neurol Neurosurg Psychiatry. 1975;38(5):459–64.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Isa K, Miyashita K, Yanagimoto S, Nagatsuka K, Naritomi H. Homonymous defect of macular vision in ischemic stroke. Eur Neurol. 2001;46(3):126–30.CrossRefPubMedGoogle Scholar
  28. 28.
    Fisher CM. The posterior cerebral artery syndrome. Can J Neurol Sci. 1986;13(3):232–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Kim JS. Posterior cerebral artery disease. In: Grotta JC, Albers GW, Broderick JP, Kasner SE, Lo EG, Mendelow AD, et al., editors. Stroke: pathophysiology, diagnosis, and management. 6th ed. Philadelphia: Elsevier; 2016. p. 393–412 .e5.CrossRefGoogle Scholar
  30. 30.
    Neau JP, Bogousslavsky J. The syndrome of posterior choroidal artery territory infarction. Ann Neurol. 1996;39(6):779–88.CrossRefPubMedGoogle Scholar
  31. 31.
    Wada K, Kimura K, Minematsu K, Yamaguchi T. Incongruous homonymous hemianopic scotoma. J Neurol Sci. 1999;163(2):179–82.CrossRefPubMedGoogle Scholar
  32. 32.
    Han YS, Lee E, Kim JS. Horizontal nystagmus and homonymous hemianopia due to lateral geniculate body hemorrhage. Eur Neurol. 2009;61(6):371–3.CrossRefPubMedGoogle Scholar
  33. 33.
    Heldner MR, Zubler C, Mattle HP, Schroth G, Weck A, Mono ML, et al. National institutes of health stroke scale score and vessel occlusion in 2152 patients with acute ischemic stroke. Stroke. 2013;44(4):1153–7.CrossRefPubMedGoogle Scholar
  34. 34.
    Smith WS, Lev MH, English JD, Camargo EC, Chou M, Johnston SC, et al. Significance of large vessel intracranial occlusion causing acute ischemic stroke and tia. Stroke. 2009;40(12):3834–40.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Gilhotra JS, Mitchell P, Healey PR, Cumming RG, Currie J. Homonymous visual field defects and stroke in an older population. Stroke. 2002;33(10):2417–20.CrossRefPubMedGoogle Scholar
  36. 36.
    Leys D, Mounier-Vehier F, Lavenu I, Rondepierre P, Pruvo JP. Anterior choroidal artery territory infarcts. Study of presumed mechanisms. Stroke. 1994;25(4):837–42.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Ondřej Volný
    • 1
    • 2
    Email author
  • Michal Haršány
    • 3
    • 4
  • Robert Mikulík
    • 5
    • 6
  1. 1.Department of NeurologySt. Anne’s University HospitalBrnoCzech Republic
  2. 2.Stroke Research ProgramSt. Anne’s University Hospital, International Clinical Research CentreBrnoCzech Republic
  3. 3.International Clinical Research CenterSt. Anne’s University Hospital and Faculty of Medicine, Masaryk UniversityBrnoCzech Republic
  4. 4.Department of Neurology, Comprehensive Stroke CenterUniversity Hospital Hradec KraloveBrnoCzech Republic
  5. 5.Department of NeurologySt. Anne’s University Hospital and Faculty of Medicine, Masaryk UniversityBrnoCzech Republic
  6. 6.International Clinical Research CenterSt. Anne’s University HospitalBrnoCzech Republic

Personalised recommendations