OPTIC RADIATIONS

Anatomy
The optic radiations extend from the lateral geniculate body to the striate cortex, which is located on the medial aspect of the occipital lobe, above and below the calcarine fissure (Fig. 21.34). The optic radiations and visual cortex have a dual blood supply from the middle and posterior cerebral arteries. As the radiations pass posteriorly, fibres from corresponding retinal elements lie progressively closer together. For this reason, incomplete hemianopia caused by lesions of the posterior radiations are more congruous than those involving the anterior radiations. Because these fibres are third-order neurons that originate in the lateral geniculate body, lesions of the optic radiations do notproduce optic atrophy.
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Figure 21.34 Visual field defects caused by lesions of the optic radiations and visual cortex

Temporal radiations
1. Visual field defect consists of a contralateral, homonymous, superior quadrantanopia ('pie in the sky'), because the inferior fibres of the optic radiations, which subserve the upper visual fields, first sweep antero-inferiorly into the temporal lobe (Meyer loop) around the anterior tip of the temporal horn of the lateral ventricle (Fig. 21.34a). 2. Associated features include contralateral hemisensory disturbance and mild hemiparesis, because the temporal radiations pass very close to the sensory and motor fibres of the internal capsule before passing posteriorly and rejoining the superior fibres. Other features of temporal lobe disease include paroxysmal olfactory and gustatory hallucinations (uncinate fits), formed visual hallucinations, seizures and receptive dysphasia if the dominant hemisphere is involved.

Anterior parietal radiations

1. Visual field defect consists of a contralateral, homonymous, inferior quadrantanopia ('pie on the floor') because the superior fibres of the radiations, which subserve the inferior visual fields, proceed directly posteriorly through the parietal lobe to the occipital cortex. A lesion involving only the anterior parietal part of the radiations is, however, very rare. In general, hemianopia resulting from parietal lobe lesions tend to be relatively congruous (Fig. 21.34b). 2. Associated features of dominant parietal lobe disease include acalculia, agraphia, left-right disorientation and finger agnosia. Non-dominant lobe lesions may cause dressing and constitutional apraxia and spatial neglect.

Main radiations
Deep in the parietal lobe, the optic radiations lie just external to the trigone and the occipital horn of the lateral ventricle. Lesions in this area usually cause a complete homonymous hemianopia (Fig. 21.34c). Optokinetic nystagmus (OKN) may be useful in localizing a lesion causing an isolated homonymous hemianopia that does not conform to any set pattern in a patient without associated neurological deficits. Normally OKN involves smooth pursuit of a target, followed by a saccade in the opposite direction to fixate on the next target. If the optomotor pathways in the posterior hemisphere are damaged, the OKN response will be diminished when targets are rotated towards the side of the lesion (i.e. away from the hemianopia). This is explained on the basis that the occipital lobe can no longer control ipsilateral pursuit, while the contralateral hemianopia inhibits re-fixational saccades. This is called the positive OKN sign. NB Incongruous homonymous hemianopia with asymmetrical OKN indicates a parietal lobe lesion. Congruous homonymous hemianopia with symmetrical OKN indicates an occipital lobe disease.