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  #1  
Old 04-26-2012
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Neuro Bilateral Cunei Damage!

This question I made! There always might be mistakes... I tried though.
==========================================

A 7-years old boy suffers recurrent infections starting from infancy, from the previous examinations, his sweat test was normal, he has no developmental abnormalities. He doesn't like sport and his parents keep him away from gyms and swimming pools. Today he presents to your office, brought by his parents. You see irritable child, markedly in distress. His parents tell you that his ears are bothering him. You examine the child and make a diagnosis of Haemophilis influenzae purulent ear infection. You prescribe the appropriate treatment. If his parents would not notice the symptoms and wouldn't ask for your help and the infection progresses, there is a possibility that advanced infection could expand onto brain. Assuming that, during this expansion, cunei is damaged bilaterally, what would be the visual field presentation of a child?

a. bitemporal hemianopia
b. binasal hemianopia
c. total blindness.
d. cortical blindness.
e. central scotomas
f. upper altitudinal hemianopia
g. lower altitudinal hemianopia
h. right hemianopia with macular sparing
k. left hemianopia with macular sparing.



...just for the sake of fun, dont break your mind
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Old 04-26-2012
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G) Lower Altitudinal Hemianopia



a. bitemporal hemianopia - Optic Chiasm Lesion
b. binasal hemianopia - Bilateral Optic tract lesion
c. total blindness. - Pretectal nuclei lesion ?
d. cortical blindness. - Cerebral cortex (area 17) lesion ?
e. central scotomas - Age related degeneration ?
f. upper altitudinal hemianopia - bilateral cunei gyrus
g. lower altitudinal hemianopia - bilateral lingual gyrus
h. right hemianopia with macular sparing - left PCA occlusion
k. left hemianopia with macular sparing. - Righ PCA occlusion


Correct me if Im wrong.. Thanks for the good review of the visual pathways!

Last edited by Hope2Pass; 04-26-2012 at 06:03 PM.
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Quote:
Originally Posted by Hope2Pass View Post
G) Lower Altitudinal Hemianopia
good job!
I see you did some serious neuro studying this week

if you not googled it only=)))

I find this concept to be the most difficult through all my neuro struggle
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Old 04-26-2012
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Quote:
Originally Posted by Hope2Pass View Post
f. upper altitudinal hemianopia - bilateral cunei gyrus
Shouldn't it be upper altitudinal hemianopia as the vignette mentions cunei is damaged bilaterally
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Old 04-26-2012
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cunei gyris receives input from UPPER hemiretina - which means lower Visual field - so if bilateral it causes lower altitudinal
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Quote:
Originally Posted by Rookie View Post
Shouldn't it be upper altitudinal hemianopia as the vignette mentions cunei is damaged bilaterally
hahhh .. I answered it right but wrote messed it up when I was rewriting out all the options. Sorry.

Correction:
f. upper altitudinal hemianopia - bilateral lingual gyrus
g. lower altitudinal hemianopia - bilateral cunei gyrus


The way I remember is - Lingual = Meyers Loop = Lateral (to cunei) = Lower (receives lower hemiretina input therefore upper quadrant visual field)

Cunei would obviously be Medial then and recieves input from upper hemiretina; therefore lower quadrant visual field.
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Quote:
Originally Posted by Hope2Pass View Post
G)
b. binasal hemianopia - Bilateral Optic tract
I believe it is due to carotid expansion, pressing on the non-decussating optic pathways
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Old 04-27-2012
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Correct Answer G is correct.

Please also see the following question I posted before:

Altitudinal Hemianopia (Altidinopia)?
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