|Year : 1954 | Volume
| 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
S N Gantayet
Department of Ophthalmology, Andhra Medical College and King George Hospital, Visakhapatnam
Source of Support: None, Conflict of Interest: None
|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 2020 Apr 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.
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.
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.
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.
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|| |
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|| |
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.
[Figure - 1]