每日一题_2023.03.27

A 64-year-old man with a history of hypertension, coronary artery disease, and type 2 diabetes presents to his physician because he “has trouble seeing.” Visual field testing reveals a defect in the left half of the visual field for both eyes, with sparing of central acuity. Which of the following is the most likely cause of the patient’s symptoms?

一名有高血压、冠状动脉疾病和2型糖尿病病史的64岁男性到他的医师处就诊，因为他“有视力障碍”。视野检查显示双眼左半视野有缺陷，中心视力有保留。下列哪一项是患者症状最可能的原因?

(A) Complete infarction of the optic chiasm 视交叉完全梗死

(B) Infarction of the lower division of the middle cerebral artery 大脑中动脉下段梗死

(C) Left retinal artery occlusion with sparing of the vessels supplying the macula 左侧视网膜动脉阻塞，黄斑供血血管保留

(D) Right posterior cerebral artery infarction with sparing of Meyer’s loop 保留Meyer环的右侧大脑后动脉梗死

(E) Right posterior cerebral artery infarction with sparing of the occipital pole 保留枕极的右侧大脑后动脉梗死

答案解析：

右侧大脑后动脉(PCA)供应右侧枕叶，负责双眼感知左侧外侧视野。枕极是枕叶的后极，这里存放着起源于黄斑的纤维。黄斑负责中心视力。因此，不包括枕极的PCA梗死会导致偏盲(在本例中为左侧同向偏盲)，但中心视力不受影响。

正确答案：E