By John Philip Patten BSc, MB, BS, FRCP (auth.)
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Extra resources for Neurological Differential Diagnosis
Sees the fingers move. At first just one hand at a time should be moved. If the patient consistently fails to see the hand on one side he may well have a full hemianopia, but if he sees the fingers move on one hand when they are moved alone, but consistently fails to see them when both hands are moved simultaneously, he has an attention hemianopia. 3. Further information may be gained from the spinning drum test to demonstrate optokinetic nystagmus (see also Chapter 7). This is the same as so-called 'railway nystagmus', where the eye follows an object until it goes out of range and then quickly moves back to pick up the next object, producing a form of pursuit nystagmus.
If the patient consistently fails to blink when threatened from one side, a hemianopic defect Vision, the Visual Fields and the Olfactory Nerve 33 can be presumed. The only special point to watch is that the hand should not get near enough to set up a draught, which will provoke a corneal response simulating blinking to threat. for an identical defect in the nasal field of the other eye to confirm that the defect is homonymous and that the scotoma noted by the patient is not due to an optic nerve or retinal lesion in one eye.
In general, if the patient is aware of his visual defect it is likely that the defect is macular splitting as it bisects the central field. If the patient is unaware of a deficit and merely bumps into things, he may have a macular sparing hemianopia or an attention hemianopia. The latter is not an absolute defect but an inability to see in one half field when vision is distracted by an object in the other half field. Testing for a homonymous hemianopia should involve three phases: 1. The examiner should test for an attention field defect.