Year : 2002 | Volume
: 18 | Issue : 2 | Page : 189--192
Homonymous hemianopsia: An unusual complication after transurethral resection of bladder tumor
Tulasi Prasad Mohapatra, Prasanna Kumar Mishra, Maya Gantayat
Department of Urology, Anaesthesiology and Neurology, MKCG Medical College, Berhampur, India
Tulasi Prasad Mohapatra
MKCG Medical College, Berhampur, Ganjam, Orissa - 760 004
|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;18:189-192
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Mohapatra TP, Mishra PK, Gantayat M. Homonymous hemianopsia: An unusual complication after transurethral resection of bladder tumor. Indian J Urol [serial online] 2002 [cited 2022 May 18 ];18:189-192
Available from: https://www.indianjurol.com/text.asp?2002/18/2/189/37645
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. , 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.
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.
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  [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.  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.  Direct pressure on visual cortex by space occupying lesions and intracerebral secondary deposits cause homonymous hemianopsia combined with loss of macular field of vision. 
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