Glyxambi
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 973
  • Home
  • Print this page
  • Email this page

   Table of Contents      
CASE REPORT
Year : 1954  |  Volume : 2  |  Issue : 2  |  Page : 48-50

A case of homonymous hemianopia after injection of anti tetanic serum


Department of Ophthalmology, Andhra Medical College and King George Hospital, Visakhapatnam, India

Correspondence Address:
S N Gantayet
Department of Ophthalmology, Andhra Medical College and King George Hospital, Visakhapatnam
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


Rights and PermissionsRights and Permissions

How to cite this article:
Gantayet S N. A case of homonymous hemianopia after injection of anti tetanic serum. Indian J Ophthalmol 1954;2:48-50

How to cite this URL:
Gantayet S N. A case of homonymous hemianopia after injection of anti tetanic serum. Indian J Ophthalmol [serial online] 1954 [cited 2019 Dec 6];2:48-50. Available from: http://www.ijo.in/text.asp?1954/2/2/48/33594

This case is reported as it would be of interest in view of the peculiar lesion of Homonymous hemianopia following administration of prophylactic anti-tetanic serum. As far as we could ascertain no similar case has been reported in the literature.

M. L. N., Hindu, male, age 35 years; married. Occupation : carpenter-­attended the Ophthalmic Department on 16-11-53 for defective vision in both the eyes after taking a prophylactic dose of anti-tetanic serum in the casualty department of this hospital on 7-11-53.

History of the case

He had first degree burns over his hands on 7-11-53 at 8-30 p.m. for which he attended the casualty department of this hospital and the following treatment was given:

(1) Anti-tetanic serum prophylactic 1 cc. subcutaneously.

(2) Sulphanilamide powder dusting, and vaseline dressing locally to the wound.

Immediately after going home, i.e. about 1 hours after the injection, he had rigor, vomiting and diarrhoea which subsided by the morning. One hour after the injection he said he could not open his eye lids though there was no swelling of the lids. On 8-11-53 he attended the Outpatient Department and was given calcium gluconate injection intra-venously. Even on 8-11-53 he was unable to open his eyes and he noticed on that day that his vision was not normal and he could not see people very near him. He also complained that light appeared dimmer and smaller in size than usual.

PREVIOUS HISTORY:

He had anti-tetanic serum in 1939 with no reaction.

There is no history of any previous illness and as faras he could judge he had no previous hemianopia.

HABITS

Smokes 4 or 5 cigars a day. A total abstainer from alcohol.

PHYSICAL EXAMINATION : on 16-11-53.

Fairly well nourished individual. No swelling of the eye lids. External eye-ball appeared normal. No pain in the eyes either on pressure or on movements. Movements of the eye-ball normal in all directions. Pupils circular and reacting to light. Fundii normal and media clear. Vision in both eyes was counting of fingers at 1 foot distance.

Field of vision taken on 17-11-53 showed left homonymous heminopia with a slight con­traction of the periphery of the remaining field and with sparing of the macula.

INVESTIGATIONS

The respiratory, circulatory, nervous systems were completely normal. Examination of the urine and serological and cytological examinations of the blood did not show anything abnormal.

Cerebro-spinal fluid could not be examined as the patient did not allow this examination.

He was given intra-muscularly vitamin & 50 mg. on alternate days and vitamin & tablets 10 mg. two tablets, twice daily.

PROGRESS

On 25-11-53.

Vision both eyes was counting of fingers at 22 metres. On 16-2-53.

L.E.V. = 6/12 with + 0.5 cyl. @ 180° = 6/9 L.E.V. = 612 with + 0.5 cyl. @ 180° = 6/9

Field of vision same as before.

He was given shark liver oil by mouth in addition.

On 11-1-54 - R.E.V. = 6/6. L.E.V. = 6/6.

The field of vision shows the same homonymous hemianopia with slight enlarge­ment of the peripheral field.

The field of vision was again taken on 24-1-54 and it showed the same defect with sparing of the macula, the periphery of field becoming almost normal. There no Wernick's Hemianopic Pupillary re-action and the fundii continued to be normal.


  Discussion Top


It is most unlikely that a hemianopia existed previously. Neither there is anything to suggest increased intracranial tension due to injury or a tumour or any other disease in the body.

Absence of optic atrophy and any disturbance of the pupillary reactions, congruous nature of fields, and sparing of the macula would place the lesion in the suprageniculate visual pathways on the right side. Absence of pyramidal tract involvement and sensory involvement show that the lesion is not in the anterior part of optic radiations. Lesions cannot be situated in the temporal lobe as there are no quadrantic field defects. So it is probably situated in the occipital lobe. The inability to open the eyes and the subjective disturbances of vision, (dimness and diminutive size of lights seen) still further point to the occipital lobe as the site of lesion as these can be due to oedema of this portion of the brain.

The sudden onset suggests a vascular lesion in the absence of history of injury. What can be the nature of the vascular lesion ? It can be due to a small bleeding or any other kind of vascular disturbance probably due to an anaphylactic reaction followed by permanent changes in the vessel. There is history of having had anti-tetanic serum before. He did not have any other manifestation of anaphylaxis except perhaps a higher eosinophilic count.

The depression of vision in the remaining field at the commencement shows that there must have been some oedema in the unaffected visual field which improved after some time, due to subsidence of oedema.


  Summary Top


A case of sudden development of homonymous hemianopia after administra­tion of antitetanic serum for prophylactic purposes after a first degree burn is reported.

The probable site and nature of the lesion are discussed.


    Figures

  [Figure - 1]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Discussion
Summary
Article Figures

 Article Access Statistics
    Viewed1814    
    Printed35    
    Emailed1    
    PDF Downloaded0    
    Comments [Add]    

Recommend this journal