Parietal Lobe Lesion

Parietal Lobe Lesion
SYMPTOMS Lid tendernessVisual inattention, Visual neglect, Sensory integration deficits
Right sided homonymous hemianopia: Difficulty seeing next letter or word
Left sided homonymous hemianopia: Difficulty finding the next line
SIGNS Fundus and optic nerves appear normal
WORK-UP Pupils (typically normal) | EOMs (typically FROM) | Cover test | Confrontations (Extinction phenomenon noted) | Color vision (Dyschromatopsia may be present)| Complete eye exam with dilation | Cranial nerve testing | Ptosis testing
Forced lid closure (There is conjugate movement of eyes opposite of the location of lesion when eyelids are forced close)
OKN drum (Abnormal) | OCT of the optic nerve | CT of the macula (Ganglion cell loss that correlates with visual field loss) | VEP
Visual field threshold 30-2 (Homonymous hemianopia that is most dense inferiorly or an inferior homonymous quadrantanopia. Lesion is on side opposite the homonymous hemianopia or quadrantanopia)
TREATMENT Refer to neuro-ophthalmologist/neurology for further evaluation and treatment
After treatment, most visual recovery is noted in 1-4 months. Visual recovery after 6 months is unlikely. If visual symptoms are still present, patient should undergo vision rehabilitation and vision restorative training (glasses, prism, tint, etc)
FOLLOW-UP Patient will likely be monitored by neurology/neuro-ophthalmology on a regular basis. Patient should be evaluated once underlying neurological etiology is in control or stable.
Monitor every 3 months for the first year and then every 6-12 months
ADDITIONAL LAB | TESTS MRI with and without contrast of the brain (concentration on the parietal lobe)
Neurological evaluation
ETIOLOGY Parietal lesions are typically due to tumors and strokes
DIFFERENTIAL DX Temporal lobe lesion, Optic chiasm lesion, Occipital lobe lesion
NOTES “PITS” Parietal lobe lesion | Inferior visual field defect | Temporal lobe lesion | Superior visual field defect.
Gerstmann’s syndrome: Lesion that involves the left parietal lobe. Right sided homonymous hemianopia that is most dense inferiorly or an inferior homonymous quadrantanopia with right-left confusion, agraphia, acalculia, aphasia, and agnosia
Balint’s syndrome: Lesions that involve both parietal lobes which leads to ocular apraxia, simultanagnosia, optic ataxia