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E. Papageorgiou, II, G. Hardiess, H.A. Mallot, B. Wilhelm, F. Schäffel, H. Wiethölter, L.F. Ticini, R. Vonthein, H.O. Karnath, U. Schiefer; Evaluation of Relative Afferent Pupillary Defect (RAPD) in Patients With Homonymous Hemianopia Due to Cerebrovascular Lesions in the Posterior and Middle Cerebral Artery Territories . Invest. Ophthalmol. Vis. Sci. 2006;47(13):791.
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(i) To assess the presence and magnitude of the relative afferent pupillary defect (RAPD) in patients with homonymous visual field defects (HVFDs), (ii) to correlate the pupillary findings with the location and extent of the cerebral lesion, and (iii) to assess the agreement of RAPDs quantified with graded neutral density filters and automated video pupillography.
RAPD was initially quantified clinically by two independent examiners with graded neutral density filters (swinging flashlight test), and secondly by means of an automated infrared videopupillographic device (SWIFT = automated SWInging Flashlight Test). The clinical assessment of the RAPD was considered as the reference standard. In order to extract the cerebral regions, which are potentially involved in the afferent pupillary pathway, the MRI scans of the patients were digitised and analysed with the software MRIcro. 15 patients (5 females, 10 males, age range: 21 to 74 years) with HVFDs due to unilateral vascular or traumatic brain lesions with a minimal visual acuity of 10/20 participated in this study.
RAPD was present in 7/15 patients. In all cases RAPD occurred contralaterally to the affected hemisphere. The analysis of the MRI scans after superimposing the lesions showed that in subjects without RAPD the lesions were typically restricted to the primary visual cortex close to the calcarine sulcus, whereas patients with RAPD had a lesion overlap that typically affected the course of the optic radiation in the temporal white matter. The center of lesion overlap in the latter group further extended into superior temporal cortex and parietal white matter. Agreement measure kappa between the main examiner and SWIFT was 0.26 (Standard error 0.26) after dichotomization at 0.3 log units.
Clear anatomical differences were revealed between patients with and without RAPD. The automatically assessed RAPD showed only fair agreement with the clinically assessed RAPD.
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