Visual Field Testing Flashcards

Which anatomical lesion is most likely to produce a bitemporal hemianopia that would score 2 on NIHSS item 3?

Answer: Optic chiasm compression or ischemia

Bitemporal hemianopia is a chiasmal lesion pattern; if it causes complete loss of both temporal fields, it scores 2.

A patient with posterior circulation stroke cannot fixate because of oculomotor dysfunction. How should the examiner adapt NIHSS item 3 visual field testing?

Answer: Use a visual threat response to each hemifield independently

Visual threat (blink response to sudden hand movement in each hemifield) can be performed even when the patient cannot fixate voluntarily.

An examiner presents two fingers simultaneously in the right and left upper quadrants. The patient reports seeing fingers only on the right. On isolated left field testing, the left upper field is intact. What is the correct NIHSS item 3 score and interpretation?

Answer: 1 — partial loss due to left visual extinction

Extinction to double simultaneous stimulation with intact fields when tested alone is scored as partial visual loss (1) under NIHSS item 3.

A patient with a large left hemisphere MCA stroke is aphasic and cannot follow commands. The examiner performs a visual threat in each hemifield. The patient blinks to threat on the left but not on the right. What NIHSS item 3 score is appropriate?

Answer: 2

Absent blink-to-threat in the entire right hemifield indicates complete right hemianopia, scored as 2.

The NIHSS item 3 scoring scale is 0–3. Which of the following correctly maps scores to findings?

Answer: 0=normal, 1=quadrantanopia/partial loss, 2=complete hemianopia, 3=bilateral blindness

The correct mapping is 0=no loss, 1=partial loss (including quadrantanopia or neglect), 2=complete hemianopia, 3=bilateral blindness.

Why might a patient with a right parietal lobe stroke fail confrontation testing in the left visual field even though formal perimetry later shows the left field is actually intact?

Answer: Hemispatial neglect causes the patient to ignore left-sided stimuli including fingers

Right parietal lesions commonly produce left hemispatial neglect, causing patients to fail to attend to left-sided stimuli on confrontation despite intact visual pathways.

A patient scores 2 on NIHSS item 3 at admission and 0 at 7-day follow-up. What is the most accurate clinical interpretation?

Answer: Significant neurological recovery has occurred in the visual system

Improvement from score 2 to 0 reflects genuine neurological recovery, as the NIHSS captures the patient's current status at each time point.