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CASE REPORT
Year : 2002  |  Volume : 18  |  Issue : 2  |  Page : 189-192
 

Homonymous hemianopsia: An un­usual complication after transurethral resection of bladder tumor


Department of Urology, Anaesthesiology and Neurology, MKCG Medical College, Berhampur, India

Correspondence Address:
Tulasi Prasad Mohapatra
MKCG Medical College, Berhampur, Ganjam, Orissa - 760 004
India
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Source of Support: None, Conflict of Interest: None


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Keywords: Transurethral; Resection of Bladder Tumor; Hemianopsia


How to cite this article:
Mohapatra TP, Mishra PK, Gantayat M. Homonymous hemianopsia: An un­usual complication after transurethral resection of bladder tumor. Indian J Urol 2002;18:189-92

How to cite this URL:
Mohapatra TP, Mishra PK, Gantayat M. Homonymous hemianopsia: An un­usual complication after transurethral resection of bladder tumor. Indian J Urol [serial online] 2002 [cited 2020 Sep 30];18:189-92. Available from: http://www.indianjurol.com/text.asp?2002/18/2/189/37645



   Introduction Top


Homonymous hemianopsia is a visual field disturbance, in which the right or left half of the binocular field of vi­sion is lost, owing to loss of vision in the temporal half of one field and nasal half of the other side. In such a situation the lesion is situated in the visual path from optic chiasma to the occipital lobe of the opposite cerebral hemi­sphere.

Use of 1.5% glycine as irrigating fluid during TUR causes raised serum ammonia level and depression of cen­tral nervous system resulting in transient reversible blind­ness, is a well documented phenomenon. [1],[2] Occurence of homonymous hemianopsia after TUR has not been re­ported and this complication is of severe mental strain for the patient as well as the treating urologist. Computerised axial tomography of brain localises the site and nature of the lesion. This case is reported for awareness of such dis­turbing complication, which may complicate any opera­tive procedure, especially in advanced age group.


   Case Report Top


A 64-year-old, non-hypertensive, non-diabetic male un­derwent transurethral resection of bladder tumor under general anaesthesia. Glycine (1.5%) was used as irrigat­ing fluid. Intraoperatively there was no fluctuation of blood pressure and bleeding was minimal. Recovery from an­aesthesia was smooth. Drugs received were injectable cefotaxime as antibiotic, pentothal as anaesthetic agent, and injectable pentazocine as sedative. Three hours after the procedure, the patient complained of mild headache and hazy vision. Twelve hours after surgery, he complained of blindness in left half of field of vision in both the eyes. Urgent ophthalmic consultation revealed left homonymous hemianopsia, with normal fundoscopy, retinoscopy and macular field of vision. A thorough neurological exami­nation could not localise any other focal brain lesion, cra­nial nerve involvement or motor and sensory deficit. CAT scan of brain detected intracerebral right occipital lobe (area 17 of Brodmann) infarction [Figure - 1]. Conservative treatment included bedrest, antibiotics and oral aspirin. In follow-up after three months, there was gradual improve­ment in field of vision in both the eyes.


   Comments Top


The fibres carrying the visual stimuli from left tempo­ral field and right nasal field after decussation are carried by right optic tract to the right visual cortex (area 17 of Brodmann). Lesion affecting right visual cortex and tract up to optic chiasma caused left side homonymous hemi­anopsia [3] [Figure - 2]. Deprived blood supply of visual cortex causing contralateral congruous homonymous hemianop­sia, is the commonest type of cortical field defect and is frequently the result of embolic occlusion of the posterior cerebral artery. [4] The macular field of vision is well pre­served as the occipital pole receives its blood supply from both the middle and posterior cerebral arteries which are seldom blocked simultaneously. [3] Direct pressure on visual cortex by space occupying lesions and intracerebral sec­ondary deposits cause homonymous hemianopsia com­bined with loss of macular field of vision. [3]

 
   References Top

1.Kaiser R, Adragna MG, Weis FR Jr, Williams D. Transient blindness following transurethral resection of the prostate in an achondroplastic dwarf. J Urol 1985; 133: 685-686.  Back to cited text no. 1    
2.Ryder KW. Hyperammonemia after TUR. A report of 2 cases. J Urol 1984; 132: 995-997.  Back to cited text no. 2    
3.Stephen JH, Miller. Symptomatic disturbances of vision. In : Par­son's diseases of the eye, 18th edn. London, Churchill Livingstone. 1990; 265-271.  Back to cited text no. 3    
4.Trobe JD, Lorber ML. Schlezinger NS. Isolated homonymous hemi­anopsia. Arch Ophthalmol 1973; 89: 377-381.  Back to cited text no. 4    


    Figures

  [Figure - 1], [Figure - 2]



 

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