Homonymous quadrinopia

Left superior homonymous quadrinopia
The optic radiation is found in both the temporal lobe and the parietal lobe. 
In a patient with a left superior homonymous quadrinopia, the lesion is likely to be in the temporal lobe. Left inferior homonymous quadrinopia is seen in lesion of the parietal lobe. 

During the examination:

  • Remember to describe the visual field as the patient sees it. Mention if the field defect is congruous (behind the lateral geniculate body) or incongruous (in the optic tract).
  • Look for other neurological signs such as hemiplegia from cerebrovascular accident.

Additional examination (the followings are related to lesion in the parietal lobe):

  • if the patient has a right inferior quadrinopia, mention that you would like to test the patient for Gertmann's syndrome. What is Gertmann's syndrome?

  • in patient with hemianopia or inferior quadrinopia, mention you like to perform the optico-kinetic drum test for evidence of parietal lobe lesion. What abnormality may you see?

Normal opticokinetic nystagmus with 
smooth pursuit movement.

Abnormal opticokinetic nystagmus with 
small saccadic movement replacement the 
smooth pursuit movement.
  • which other higher sensory perceptions are impaired?

  • test for sensory inattention. How do you test for sensory inattention?

Left inferior homonymous quadrinopia