Hemianopsia: species, effective drugs

Visual impairment, which occurs as a result of damage to visual innervation or structural damage to the brain, is called the term "hemianopsia". This disorder is both congenital and acquired, and represents a bilateral loss of vision in the fourth or second part of the visual field.

[1], [2]

Epidemiology

The hemianopsia can be congenital, or acquired. The acquired form is the result of damage to various brain structures. The congenital form often develops in the presence of other pathologies of the central nervous system (hemianopsia with an isolated course - this is an extremely rare disorder).

In the overwhelming majority of cases of hemianopsia, a disorder is found in the occipital cerebral lobe, a little less often in the parietal and temporal, and very rarely in the visual apparatus and the lateral geniculate body.

The acquired form is more often diagnosed in female patients.

Hemianopsia can occur in people of any age, but most often the diagnosis is set at 30-50 years.

[3], [4], [5], [6], [7], [8],

Causes of the hemianopsia

The causes of the development of hemianopsia can be congenital, or acquired.

Congenital hemianopsia develops against a background of various failures in the fetal development of the fetus, or as a result of violations of the pregnancy - for example, with severe oxygen deficiency, with lesions by viruses or bacteria, with organic pathology of the central nervous system, etc.

The acquired form of the disease can develop as a result of such painful processes:

• basal form of meningitis;
• Infectious inflammation in the form of meningoencephalitis, encephalitis;
• purulent inflammation, brain abscess;
• aneurysms of the arteries;
• a disorder of blood flow in the brain after mechanical damage (trauma, injury, shaking);
• Oncology affecting the pituitary gland, posterior, frontal and temporal lobes;
• hypertensive disease;
• intracranial hypertension;
• increased thrombus formation in retinal vessels;
• damage to the myelin sheath of nerves;
• violation of trophism, extreme exhaustion of the body.

The hemianopsia of the cause of vascular character does not reject, rather the opposite: the state of the cerebral vessels directly affects the development of visual pathology.

For example, often there is a hemianopia in stroke - if the treatment is started in time, then this violation in the post-sultanal period is transient.

[9], [10], [11], [12]

Risk factors

The main risk factors for the development of hemianopsia are considered to be conditions leading to impaired blood flow in the brain tissues, as well as intracranial tumor processes, traumas and injuries of the skull, purulent inflammatory processes, and aneurysms in the brain base zone.

[13], [14], [15]

Pathogenesis

It is believed that the most common factor in the development of hemianopsy are neoplasms arising in the zone of the Turkish saddle, as well as vascular aneurysms of the Willis circle, CCT, and optochiasmal inflammation of the arachnoid membrane.

The visual system is damaged by craniopharyngiomas, neoplasms in the pituitary gland, tumor processes in the temporal lobe, aneurysms. The central neuron of the vision pathway and the cortical centers of vision are affected by tumors in the temporal or occipital brain lobes, TBI, and aneurysms.

Hemianopsia develops as a result of organic disorders of the brain structures responsible for vision. This is considered the main topographic and diagnostic manifestation of damage to the path of vision at its various points, and primarily in the brain.

[16], [17], [18], [19],

Symptoms of the hemianopsia

The hemianopsia finds itself a failure of the visual function, which is accompanied by:

• pain in the head;
• fainting and fainting;
• increased sensitivity to light stimuli;
• paresthesias of the extremities.

The first signs depend on the cause of the appearance of hemianopsia. For example, the "fallout" of individual areas of the field of view can manifest itself in different ways. Thus, the outer halves of the visible image may disappear, either internal, etc. Such features of the symptomatology are reflected in the classification of hemianopsia.

Scotoma and hemianopsia

Speaking of scotoma, they mean a dark zone in the visual field. This zone is different - in the form of a circle, an oval, a triangle. It is formed in any part of the visual field and has nothing to do with its outline.

The scotoma is not always the same, therefore the following types are distinguished:

• positive appearance - explained by patients, as a darkened speck, which occurs when there is damage to the vitreous;
• negative appearance - appears as a result of damage to the path of vision, almost invisible to the patient;
• ciliary appearance - explained by patients, as a contour flicker, arising on the background of migraine.

The scotoma happens both on one side and on both sides. Their appearance is mainly due to such causes:

• hypophyseal neoplasms;
• damage to the myelin covering of neurons;
• persistent high blood pressure;
• the state of pre-eclampsia in pregnancy;
• prolonged intoxication;
• severe exhaustion of the body;
• pronounced and frequent migraines;
• increased ICP;
• thrombus formation of retinal vessels.

Scotoma is most often noticed by the patient himself, so the disease is detected at the very beginning of its development. The ciliary appearance of pathology in the elderly can indicate the likelihood of an early stroke.

[20], [21], [22], [23]

Forms

Such a pathology, as hemianopsia, can proceed in different ways. For this reason, several types of this disease are distinguished.

• Homonymous hemianopsia is a symmetrical loss of a pair of left or a pair of right halves of the field of view. For example, the patient is able to see only the inner half of the left eye and the outer half of the right eye, or vice versa. Under half is meant part of the visual picture.
• Heterinemic hemianopsia is the loss of a pair of external halves, or pairs of internal halves of the field of view. Most often, the causes of this phenomenon are pathological changes in the cerebral cortex of the occipital lobe.
• Bitemporal hemianopsia is an heteronomous type of disease with loss of a pair of external halves of the visual field.
• Right-sided hemianopsia is a kind of homonymous type, when the patient feels only the right half of the visual field. In this case, the boundary line separating the perceived and lost halves coincides with the central vertical meridian.
• Left-sided hemianopsia is a homonymous violation, the opposite of right-sided hemianopsia. In this case, the patient feels only the left half of the visual field.
• Binasal hemianopsia is an heteronomous type of disease, in which a pair of internal (nasal) halves of the visual field is lost.
• Contralateral hemianopsia refers to the homonymous type and is diagnosed when the occipital part of the cortex is affected. Often this is the result of a stroke. In a number of cases, such a violation is transient.
• The visual field is conditionally divided into quadrants, for the convenience of a diagnostic description of the disease. The term "quadrant hemianopsia" allows one to accurately describe the localization of a dark spot that interferes with visual perception. Depending on in which sector (quadrant) the spot is located, distinguish the lower-quadrant and lower-quadrant hemianopsia.
• Lower-quadrant hemianopsia is characterized by a lesion of the cerebral cortex, with an upper localization with respect to the furrow groove.
• Verkhnekvadrantnaya hemianopsia develops when there is a lesion of the cerebral cortex, with a lower location relative to the furrow of the temporo-occipital segment.
• Partial hemianopsia is an incomplete loss of the visual field, on which spots of different sizes appear. As a rule, partial hemianopsia is observed at the initial stage of development of pathology.
• Bilateral hemianopia, which is otherwise called bilateral, is characterized by the localization of visual disturbance in two halves of the visual field.
• Tractus hemianopsia is a homonymous type of disease in which the pathological focus in diagnosis interrupts the arc of the pupillary reflex. In this case, diagnosis is the definition of pupil response to a light stimulus.

[24], [25], [26], [27]

Complications and consequences

If you do not treat hemianopsia, do not have general or symptomatic interventions, or treat the disease incorrectly, the pathology will gradually progress. Vision will deteriorate, the visual picture will decrease in size.

The most common results of untreated hemianopsia are atrophic processes in the optic nerve, an increase in the size of the "blind" spot, up to the total loss of visual function.

[28], [29], [30]

Diagnostics of the hemianopsia

Diagnostic measures for determining hemianopsia include procedures that assess the quality of visual function, the breadth of the visual field. If the hemianopsia has only entered the first phase of development, then it is not always possible to detect it. The fact is that at the initial stage there are no pathological changes in the fundus, and the first signs appear about a year after the onset of the painful process.

Analyzes in the laboratory can be prescribed only to clarify the overall health, to assess the health of the liver and kidneys, as well as blood paintings.

Instrumental diagnostics can include:

• computed tomography;
• radiography;
• carotid angiography;
• Ultrasound;
• MRI of the brain.

If a tumor process is detected, the doctor may recommend the delivery of an assay for the maintenance of certain hormones in the blood.

In addition, it is possible to conduct a special diagnostic test, which consists of the following stages:

• The doctor and the patient face to face, about a meter distance.
• Both the doctor and the patient have one eye covered with a dense bandage.
• The patient looks at the doctor's unguarded eye.
• The doctor moves the finger at an equal distance from the patient and from himself, starting from the periphery to the center. At the moment when the patient sees a finger in the visual field, he tells the doctor about it.
• Normally, the test scores of the doctor and patient should coincide. If there is a discrepancy in the indicators, a violation of visual function in the patient is suspected.

[31], [32], [33], [34], [35]

Differential diagnosis

Differential diagnosis of hemianopsia is carried out with such pathologies as ischemic neuropathy, glaucoma, retinal diseases. To clarify the diseases, such studies are carried out:

• vasometry;
• ophthalmoscopy;
• tomography, dopplerography.

In some cases, it may be necessary to consult a neurologist, a neurosurgeon.

Treatment of the hemianopsia

To eliminate hemianopsia and correction of the visual field, you need to completely get rid of the cause of the pathology. If this is not done, then it will be impossible to cure the hemianopsia, and in the future the progression of the disease will lead to complete blindness. For example, with neurological pathologies, surgical treatment can be prescribed, chemotherapy treatment - the choice of treatment depends on the variety and neglect of the problem.

Medicines for hemianopsia are practically not used, as there is no positive dynamics in conservative treatment. However, there are a number of drugs that are used to improve the quality of life of the patient. Such preparations, for example, include:

• Sumatriptan - used to stop acute attacks of headache and migraine, 1 tablet during an attack. In a day, you can take no more than 2-3 tablets. Side effects - allergies, lower blood pressure, pain in the chest and stomach.
• Memoplant - used for visual impairment of vascular genesis, 1 tablet three times a day with food. Approximate duration of admission is 12 weeks. Side effects - nausea, allergies, instability of the stool.
• Cerebrolysin - is prescribed for organic pathologies of the brain, with post-stroke complications, craniocerebral trauma. The drug is injected: up to 5 ml in the form of intramuscular injections, and up to 10-50 ml in the form of intravenous injections. Among the side effects: rarely - tachycardia, pain at the injection site.
• Cerebroton - used in hemianopsia vascular genesis, 1-2 tablets three times a day, regardless of food intake. Duration of admission is 1,5-2 months. Rare side effects - nausea, allergies.

Vitamins

With a varied and nutritious diet, there is no special need for additional vitamin preparations. In other cases, the doctor can prescribe special vitamin complexes, as a supplement to the main treatment of hemianopsia.

Most often, with hemianopsia, the following vitamin preparations are recommended:

• Lutein complex - take one tablet 1-3 times a day.
• Optix - a vitamin-mineral complex preparation, take on a pill daily for 3 months.
• Dopplergets Vitamins for eyes with lutein - allow to restore blood circulation and improve the quality of visual function. Take daily for a long time.
• Focus forte is used daily for one and a half to two months.

Vitamins are used only against the background of the main therapy of hemianopsia, and they must be taken systematically, for a long time.

Physiotherapeutic treatment

Physiotherapy and balneotherapy in the first place will suit patients in whom hemianopsia is the consequence of ischemic impairment. With transient abnormalities during the remission period, a general galvanization, galvanic collar, inductothermy, prolonged diathermy of the kidney and ankle zone, as well as UHF on the foot zone or solar plexus, and Vermel's electrophoresis are prescribed.

Patients with hemianopsy on a background of hypertension apply Ca-electrophoresis to the sino-carotid region, or a course of radon baths. The suggested procedures are best carried out every other day, and radon can be changed by coniferous baths.

Patients in whom hemianopsia became the consequence of dynamic circulatory disorders are allowed to use hydrogen sulphide baths simultaneously with oxygen therapy, as well as exercise therapy.

Contraindications to the appointment of physiotherapy in hemianopsia are diseases of the cardiovascular system (infarction, angina pectoris), circulatory disorders in the brain associated with an aneurysm or the third stage of hypertension.

Alternative treatment

• In order to stabilize blood pressure and clean blood vessels for hemianopsia use such a tool. Wash and grind the meat grinder for two fruits of orange and lemon, together with the skin. To the resulting mass add 2 tbsp. L. Honey and stand the drug for 24 hours at room temperature. Next, the mass is poured into a glass container and placed in a refrigerator, taking 1 tbsp. L. Three times a day. The duration of such treatment is not limited. You can wash down the remedy with warm unsweetened tea.
• With gemianopsy use another popular remedy. Grind five cloves of garlic, add the same amount of wiped horseradish, pour the mass with dark sunflower oil. The mass is placed in a refrigerator and taken daily for 1 tsp. Simultaneously with the intake of 1 tsp. Lemon juice, three times a day. The course of admission can last from 4 to 12 weeks, the loan should take a break for one month.
• A good effect with hemianopsia is obtained by treatment with tincture of a golden mustache. To prepare tincture, cut off 35 "jointers" of a golden mustache, crush, insist in medical alcohol for two weeks, filter. Consume 1 dess. L. Tinctures together with 1 tbsp. L. Dark sunflower oil. The medicine is taken 20 minutes before meals, three times a day. The course of admission is 10 days, after which it is necessary to take a break for 5 days. Then again, the course is 10 days, but the next break should already be 10 days. So alternate between five and ten-day breaks, until the medicine is over.

Herbal Treatment

• Tincture of hawthorn is taken during the month for 25 drops per day. Then you should take a break for 2 weeks, and after that you can resume the course.
• Prepare a decoction of 10 silky leaves and 500 ml of boiling water. Hold on low heat for 2 minutes, then insist 20-30 minutes. Use daily instead of tea. The course can last from 3 to 4 months. The mulberry helps to stabilize blood pressure and normalizes blood vessels.
• Collect 12 medium cones in a pine forest, wash them, grind and pour 500 ml of good vodka, insist 2 weeks. Take 1 tsp. With warm tea. The course of therapy lasts 7 days, after which they take a break for one month.
• Prepare a mixture of 10 g of lemon balm, 10 g of Veronica, 30 g of strawberry leaves, 40 g of color or hawthorn berries. Take 1 tbsp. L. Obtained raw materials and poured 300 ml of boiling water. Filter and drink instead of tea daily, to improve well-being. It is allowed to add honey to a warm drink.

Homeopathy

The decision on the use of homeopathic remedies for hemianopsia should be agreed with the doctor, after a thorough study of the clinical picture, carrying out specifying diagnostic studies. Depending on the reason, such means of homeopathy can be recommended:

• Aurum iodine, Barium carbonicum - improve blood circulation in the brain;
• Conium - normalizes vascular tone, is especially relevant in the postinsult period;
• Kretegus, Arnika - have a positive effect on cerebral circulation;
• Ignatius amara - will help with hemianopsia, which proceeds with headaches and high blood pressure;
• Cactus grandiflorus, Opium - stabilize the pressure in hypertension;
• Staphisargria - improves vascular tone, normalizes the pressure in the vessels.

A huge plus of homeopathy is the absence of side effects during treatment. However, experts do not provide general recommendations on dosages: the dose is set individually, depending on the characteristics of the disease and on the patient's constitution.

Surgery

Surgical treatment for hemianopsia is indicated if its cause is cancer. Carry out removal of the tumor, as well as chemotherapy and radiation therapy.

The hemianopia associated with craniocerebral trauma may also require surgical intervention, which is usually removal of the hematoma, suturing damaged tissue and vessels.

Prevention

Hemianopsia is an insidious disease. And, first of all, in the sense that at the initial stage of development it is practically impossible to detect hemianopsia. To protect yourself from trouble, it is advisable to be examined annually from the oculist.

In addition, we should pay attention to a number of preventive measures:

• It is important to comply with safety technology in production, during exercise, when driving a car, and in all other cases when there is an increased risk of injury to the head.
• If there are signs of a tumor process in the brain (convulsions, vestibular disorders, strabismus), you must always go to a neurologist and go through all the stages of diagnosis.
• In summer it is necessary to take measures to prevent bites of encephalitic ticks.
• At any time of the year, it is necessary to prevent the appearance of infectious pathologies, to strengthen immune protection.

[36], [37], [38], [39]

Forecast

Restoration of the full visual image is possible, but the likelihood of such a positive outcome depends on many reasons:

• from the complexity of the pathology, which led to the development of hemianopsia;
• from the prescribed treatment;
• from the duration of the visual disorder;
• from the stage of the pathological process;
• from the age and general health of the patient.

Typically, the recovery occurs within six months after the start of treatment, or does not happen at all. If the disease is started, or treatment was started late, hemianopsia may result in partial or total loss of vision.

[40], [41], [42], [43]