Jean-Martin Charcot, often lauded for his seminal contributions, is seldom critiqued for his blunders. One such blunder was his double-semidecussation scheme for the retinocortical visual pathways, proposed in 1875 to explain, on neuroanatomic grounds, cases of hysteria that manifest hysterical amblyopia accompanied with ipsilateral hemianaesthesia. Charcot\'s scheme was inconsistent with the older, broadly correct scheme of Prussian ophthalmologist Albrecht von Gräfe. Charcot failed to perform clinicopathologic correlation studies. His analysis relied on a series of mistaken conclusions he made in conjunction with Swiss-French ophthalmologist Edmund Landolt: (1) only an optic tract lesion could produce a homonymous hemianopsia; (2) cerebral lesions, if they ever produced homonymous hemianopsia, did so by secondary effects (e.g. pressure) on the optic tracts; and (3) damage to the cortical projections from the lateral geniculate produces a crossed amblyopia. Challenges to Charcot\'s theory came from within France by 1880. By 1882, Charcot recognized that his scheme was erroneous, and he approved a thesis by his pupil Charles Féré that reverted to Gräfe\'s scheme with an ill-conceived modification to accommodate Charcot\'s concept of hysterical cerebral amblyopia. A critique by American neurologist Moses Starr in 1884 argued for Gräfe\'s scheme and refuted Charcot\'s erroneous scheme and its subsequent derivatives.

BACKGROUND: Bitemporal hemianopia is usually caused by chiasmal pathology. Rarely, chorioretinal lesions may develop symmetrically in both eyes and mimic chiasmopathy.
METHODS: This case series included three patients who presented to a tertiary neuro-ophthalmology centre with bitemporal hemianopic defects between 2021 and 2023 and were subsequently diagnosed with bilateral chorioretinopathy. All patients received comprehensive examinations from a fellowship-trained neuro-ophthalmologist and uveitis specialist to rule out other causes of visual dysfunction.
RESULTS: Three males aged 64, 62, and 72 years were included. All patients showed bitemporal hemianopic defects crossing the vertical midline on automated perimetry and binasal thinning of the macular ganglion cell complex on spectral-domain optical coherence tomography (OCT). Fundus autofluorescence (FAF) showed classical features of acute zonal occult outer retinopathy (AZOOR) in two patients and central serous chorioretinopathy (CSCR) in another. AZOOR diagnosis was preceded by neuroimaging in both cases, whereas the patient with CSCR had longstanding, electroretinography-confirmed lesions and did not require neuroimaging. Fundus appearance and visual field defects remained stable in all patients across 3-6 months of follow-up.
CONCLUSIONS: Bilateral chorioretinopathy should be considered in the differential diagnosis of bitemporal hemianopia in specific cases, including when visual field defects cross the vertical midline and when neuroimaging fails to reveal chiasmal pathology. FAF and macular OCT have high diagnostic yield as initial investigations.

UNASSIGNED: The purpose of this study was to investigate gaze-scanning by pedestrians with homonymous hemianopia (HH) when walking on mid-block sidewalks.
UNASSIGNED: Pedestrians with right homonymous hemianopia (RHH), and left homonymous hemianopia (LHH) without and with left spatial neglect (LHSN) walked on city streets wearing a gaze-tracking system. Gaze points were obtained by combining head movement and eye-in-head movement. Mixed-effects regression models were used to compare horizontal gaze scan magnitudes and rates between the side of the hemi-field loss (BlindSide) and the seeing side (SeeingSide), among the three subject groups, and between mid-block walking and street crossing segments.
UNASSIGNED: A total of 7021 gaze scans were obtained from 341 minutes of mid-block walking videos by 19 participants (6 with LHH, 7 with RHH, and 6 with LHSN). The average gaze magnitude and scanning rate in mid-block segments were significantly higher towards the BlindSide than the SeeingSide in LHH (magnitude larger by 1.9° (degrees), P = 0.006; scan rate higher by 4.2 scans/minute, P < 0.001) and RHH subjects (magnitude larger by 3.3°, P < 0.001; scan rate higher by 3.2 scans/minute, P = 0.002), but they were not significantly different in LHSN subjects. The scanning rate, in terms of scans/minute (mean, 95% confidence interval [CI]) was significantly lower in LHSN subjects (mean = 6.9, 95% CI = 5.6-8.7) than LHH (mean = 10.2, 95% CI = 8.0-13.1; P = 0.03) and RHH (mean = 11.1, 95% CI = 9.0-13.7; P = 0.007) subjects. Compared to street-crossings, the scan rate during the mid-block segments was lower by 3.5 scans/minute (P < 0.001) and the gaze magnitude was smaller by 3.8° (P < 0.001) over the 3 groups.
UNASSIGNED: Evidence of compensatory scanning suggests a proactive, top-down mechanism driving gaze in HH. The presence of spatial neglect (SN) appeared to negatively impact the top-down process.

CONCLUSIONS: Performance-based outcome measures are crucial for clinical trials of field expansion devices. We implemented a test simulating a real-world mobility situation, focusing on detection of a colliding pedestrian among multiple noncolliding pedestrians, suitable for measuring the effects of homonymous hemianopia and assistive devices in clinical trials.
OBJECTIVE: In preparation for deploying the test in a multisite clinical trial, we conducted a pilot study to gather preliminary data on blind-side collision detection performance with multiperiscopic peripheral prisms compared with Fresnel peripheral prisms. We tested the hypothesis that detection rates for colliding pedestrians approaching on a 40° bearing angle (close to the highest collision risk when walking) would be higher with 100Δ oblique multiperiscopic (≈42° expansion) than 65Δ oblique Fresnel peripheral prisms (≈32° expansion).
METHODS: Six participants with homonymous hemianopia completed the test with and without each type of prism glasses, after using them in daily mobility for a minimum of 4 weeks. The test, presented as a video on a large screen, simulated walking through a busy shopping mall. Colliding pedestrians approached from the left or the right on a bearing angle of 20 or 40°.
RESULTS: Overall, blind-side detection was only 23% without prisms but improved to 73% with prisms. For multiperiscopic prisms, blind-side detection was significantly higher with than without prisms at 40° (88 vs. 0%) and 20° (75 vs. 0%). For Fresnel peripheral prisms, blind-side detection rates were not significantly higher with than without prisms at 40° (38 vs. 0%) but were significantly higher with prisms at 20° (94 vs. 56%). At 40°, detection rates were significantly higher with multiperiscopic than Fresnel prisms (88 vs. 38%).
CONCLUSIONS: The collision detection test is suitable for evaluating the effects of hemianopia and prism glasses on collision detection, confirming its readiness to serve as the primary outcome measure in the upcoming clinical trial.

A new functional deficit caused by a stroke can be understood as a situation of uncertainty that has to prompt deficit discovery and subsequent incorporation into an altered self-perception. Anosognosia for visual field deficits is frequent after stroke. For hemiplegia, patients\' performance in a riddle test provided evidence that the inability to generate and adjust beliefs in face of uncertainty contributes to anosognosia for hemiplegia. In this prospective study, the same riddles are used in patients with homonymous hemianopia due to a first-ever stroke in the posterior cerebral artery territory and in an age-matched control cohort. The riddles create a situation of uncertainty that is resolved with five successive clues which progressively delimit the target word. After each clue, patients have to guess the target word and rate their confidence in the answer\'s correctness. Patients were tested once during the hospital stay. According to the Bisiach score for anosognosia, 12 out of 29 patients were unaware of their visual field deficits. All patients with anosognosia for hemianopia had right hemisphere lesions. Patients with and without anosognosia did not differ significantly in global cognitive impairment, mental flexibility or memory function. Importantly, patients with anosognosia showed higher confidence ratings than patients without anosognosia and controls in the first two clues (situations of uncertainty). This was demonstrated by a significant interaction effect in a mixed ANOVA with the factors group (anosognosia, nosognosia, controls) and riddle clues. An exploratory lesion subtraction analysis showed a high proportion of deficit unawareness in patients with lesions in the right fusiform and (para)hippocampal gyri. Our findings suggest that overconfidence in situations of uncertainty might contribute to the appearance of anosognosia for hemianopia. Because this has been demonstrated before in anosognosia for hemiplegia, we suggest that overconfidence is a supra-modal contributor to deficit unawareness.

This case report presents a rare case of infantile nystagmus syndrome (INS) in which the direction of infantile nystagmus (IN) was vertical. A 66-year-old woman was referred to our department for investigation of abnormal eye movements. She showed a disordered field of view with a homonymous hemianopia in the lower left quadrant and vertical gaze-evoked nystagmus, but there were no other abnormal neurological findings. She did not complain of an oscillopsia. Imaging revealed that the cause of hemianopia was atrophy and low cerebral blood flow in the right occipital lobe. The vertical nystagmus became strong when attempting to fixate to stationary targets. A reversed optokinetic nystagmus response was observed in the vertical optokinetic nystagmus test. From these eye movements, we diagnosed her nystagmus as vertical IN. Patients with INS see everything by saccades. IN consists of the alternate appearance of saccades and preceding slow eye movements. For these eye movements, a wide visual field is necessary. In this case, vertical IN was caused by the wider vertical than horizontal visual field resulting from homonymous hemianopia. Therefore, the direction of IN is horizontal in most patients with INS because their horizontal visual field is the widest field.

Introduction: We report an epileptic patient who experienced hallucinatory visual experiences of autobiographical memories from her past. These visual experiences were confined to the lower left quadrant of her visual field.Methods: We carried out a single-case study that used brain-imaging, EEG and behavioural methods to study this patient.Results: We found that this patient had an incomplete left inferior homonymous quadrantanopia due to a lesion of right occipital cortex, and also that she showed neurological abnormalities in right temporal cortex, a region that is part of the brain\'s autobiographical-memory circuit.Conclusion: We attribute the occurrence of this patient\'s autobiographical-memory hallucinations to the combination of degraded visual input to right temporal cortex plus hyperexcitability of that region.

BACKGROUND: Early venous drainage is a critical diagnostic feature of arteriovenous malformations (AVMs) and arteriovenous fistulas (AVFs). However, other conditions associated with early venous drainage can mimic AVMs and AVFs and mislead the treating physician team.
METHODS: The authors present a unique case of a 56-year-old man with new left hemianopsia. Workup with magnetic resonance imaging and magnetic resonance angiography had revealed cortical enhancement and early venous drainage, possibly caused by an AVF or AVM. Catheter angiography confirmed the presence of early venous drainage of specifically the right occipital lobe. The early venous drainage occurred as the result of local hyperperfusion limited to the right occipital lobe. Subsequent electroencephalography confirmed focal seizure activity in the right occipital lobe. After seizure control with multiple antiepileptic medications, the patient regained his vision. Repeat digital subtraction angiography revealed restoration of normal cerebral blood flow.
CONCLUSIONS: Early venous drainage observed during catheter angiography can be associated with seizure activity. Differentiation from other conditions, such as AVM, AVF, or ischemic stroke, is critical to facilitate prompt and appropriate treatment.

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OBJECTIVE: Homonymous hemianopia caused by cerebrovascular disease may improve over time. This study investigated whether functional neuroimaging can predict the prognosis of hemianopia due to cerebral infarction.
METHODS: We studied 19 patients (10 men and 9 women) with homonymous hemianopia and compared them with 34 healthy subjects (20 men and 14 women). Cerebral glucose metabolism was measured by 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), 1 to 6 months after the onset. Bilateral regions of interest (ROIs) were selected from the posterior and, anterior striate cortices, extrastriate cortex, and thalamus. Furthermore, semi-quantitative data on cerebral glucose metabolism were obtained for ROIs and compared with the data obtained for homologous regions in the contralateral hemisphere by calculating the ipsilateral/contralateral (I/C) ratio.
RESULTS: The I/C ratio for the cerebral glucose metabolism in the posterior striate cortex was high (>0.750) in 8 patients, and the central visual field of these patients improved or showed macular sparing. The I/C ratio for cerebral glucose metabolism in the anterior striate cortex was high (>0.830) in 7 patients, and the peripheral visual field of these patients improved. However, no improvement was observed in 9 patients with a low I/C ratio for cerebral glucose metabolism in both the posterior and anterior striate cortices.
CONCLUSIONS: Measurement of cerebral glucose metabolism in the striate cortex is useful for estimating visual field prognosis. Furthermore, FDG-PET is useful in predicting the prognosis of hemianopia.