Optical coherence tomography in an optic tract lesion: Retinal nerve fiber layer changes.

A 49-year-old woman, status post temporal lobe resection, reported a hemianopia. Examination revealed a right afferent pupillary defect, horizontal bow-tie atrophy OD (temporal and nasal), and temporal atrophy OS. Optical coherence tomography showed a bow-tie pattern OD and predominant superior and inferior nerve fiber layer loss OS (figure 1; figure e-1 at [Neurology.org][1]). The pattern OD is due to the combination of papillomacular bundle and nasal RNFL loss. The pattern OS is due to nerve fiber layer loss temporal to the fovea and, coupled with papillomacular bundle loss, produces temporal pallor.1 MRI confirmed left optic tract atrophy (figure 2). Optical coherence tomography may be sensitive for detecting localizing atrophic patterns.2 [1]: http://neurology.org/lookup/doi/10.1212/WNL.0000000000003310