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Anatomy

Central Nervous System

Question 53 of 82

Which of the following clinical features is most suggestive of a lesion of the occipital lobe:

Answer:

Homonymous hemianopia is most likely caused by damage to the occipital lobe.

Occipital Lobe

The occipital lobe rests inferiorly upon the tentorium cerebelli which segregates the cerebrum from the cerebellum. The parieto-occipital sulcus separates the occipital lobe from the parietal and temporal lobes anteriorly.

By BruceBlaus (Own work) [CC BY 3.0 , via Wikimedia Commons

Lobes of the Brain. (Image by BruceBlaus (Own work) [CC BY 3.0 , via Wikimedia Commons)

Cortical Areas

The primary visual cortex is located within the occipital lobe and together with the visual association cortex is responsible for vision.

By Blausen.com staff. "Blausen gallery 2014, via Wikimedia Commons

Motor and Sensory Regions of the Cerebral Cortex. (Image by Blausen.com staff. “Blausen gallery 2014, via Wikimedia Commons)

Blood Supply

The blood supply to the occipital lobe is from the posterior cerebral artery, but the occipital poles, serving macular vision, have additional supply from a branch of the middle cerebral artery.

By derivative work: Frank Gaillard (talk) Brain_stem_normal_human.svg: Patrick J. Lynch, medical illustrator (Brain_stem_normal_human.svg) [GFDL 1.3 (www.gnu.org/licenses/fdl-1.3.html), GFDL 1.3 (www.gnu.org/licenses/fdl-1.3.html), CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0) or CC BY 2.5 (http://creativecommons.org/licenses/by/2.5)], via Wikimedia Commons

Cerebral Blood Supply. (Image by derivative work: Frank Gaillard (talk) Brain_stem_normal_human.svg: Patrick J. Lynch, medical illustrator (Brain_stem_normal_human.svg) [GFDL 1.3 (www.gnu.org/licenses/fdl-1.3.html), via Wikimedia Commons)

Clinical Implications

Damage to the occipital lobe can result in:

  • Contralateral homonymous hemianopia (with macular sparing)
  • Cortical blindness
  • Visual agnosia
  • Colour blindness
  • Visual illusions or hallucinations
  • Difficulty reading and writing

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l
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