American Journal of Physical Medicine & Rehabilitation Articles Ahead of Print 10.1097/PHM.0000000000000936 Reversible Visual Field Defect after Isolated Intraventricular Hemorrhage Youngkook Kim, MD; Bo Young Hong, MD, PhD; Joon-Sung Kim, MD, PhD D Youngkook Kim, Department of Rehabilitation Medicine, RHIN Hospital, Korea Bo Young Hong, Department of Rehabilitation Medicine, St. Vincent’s Hospital, EP TE College of Medicine, The Catholic University of Korea Joon-Sung Kim, Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea Corresponding Author: Youngkook Kim C Department of Rehabilitation Medicine, RHIN Hospital, Korea 15, Poeun-daero 59beon-gil, Suji-gu, Yongin-si, Gyeonggi-do, Republic of Korea, A C 16864 E-mail: england2@hanmail.net Acknowledgements: None Author Disclosures: Youngkook Kim – Reports no disclosures Bo Young Hong – Reports no disclosures Joon-Sung Kim – Reports no disclosures 1 Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. A 40-year-old man was referred for cognitive rehabilitation after external ventricular drainage for an isolated intraventricular hemorrhage (IVH) (Fig 1. A). A visual assessment was performed because the patient’s mother reported that he had difficulty with prompt perception of objects, although he was not aware of any visual loss. His left eye has been completely blind since the age of 20 years due to Moyamoya disease. suggesting a retrogeniculate lesion (Fig 1. D). D Automated visual perimetry for the right eye showed a right superior quadrantanopia The cause of quadrantanopia was unclear, as the patient had Moyamoya disease with a EP TE history of complete blindness in the left eye. Brain magnetic resonance imaging was performed including diffusion-weighted imaging (DWI) and diffusion tensor imaging to differentiate between cortical blindness and optic radiation injury at 1 month after onset of symptoms. We found no evidence of cerebral ischemia on DWI, and diffusion tensor tractography of the optic radiation revealed degeneration of the left Meyer’s loop with lateral ventricular enlargement (Fig 1. B, C). The visual field was restored five months later (Fig 1. E). C Meyer’s loop passes around the inferior horn of the lateral ventricle before reaching A C the primary visual cortex; thus, lateral ventricular enlargement caused by IVH may temporarily damage Meyer’s loop.1, 2 Our case shows that visual field defect caused by IVH may be reversible and illustrates the clinical usefulness of diffusion tensor tractography for verifying optic radiation abnormalities involving subtle structural damage in the ventricles or retrogeniculate visual pathway. 2 Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. Figure Legend Figure 1. Diffusion tensor tractography of the optic radiation. Lateral intraventricular hemorrhage in the initial CT (A) and MRI at 1 month (B). Dilated lateral ventricle (asterisk), degenerated Meyer’s loop (arrow) and lateral geniculate body (red dot, left; A C C EP TE D blue dot; right, C). Visual field at 1 month (D) and 5 months (E). 3 Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. References 1. Guzzetta A, Fiori S, Scelfo D, Conti E, Bancale A. Reorganization of visual fields after periventricular haemorrhagic infarction: potentials and limitations. Developmental medicine and child neurology 2013;55 Suppl 4:23-6. 2. Jang SH, Seo JP. Optic radiation injury in a patient with intraventricular hemorrhage: a diffusion tensor tractography study. Neural regeneration research A C C EP TE D 2016;11:1013-4. 4 Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. A C C EP TE D Figure 1 5 Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.