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Teaching NeuroImages: Distinct visual anosognosia after serial lesions of Meyer loop and the lateral geniculate body

A 65-year-old man with previous left temporal glioma resection presented complaining of an unprecedented homonymous upper right field defect. Anopia in this quadrant had been documented using confrontation testing 6 months before, indicating prior anosognosia. Repeated perimetry showed right-sided homonymous hemianopia, revealing novel anosognosia for the lower quadrant (figure 1). On MRI, there was no tumor relapse or other cortical damage, but ischemia including the lateral geniculate body (figure 2). Anosognosia is not limited to damage of visual cortical areas and is frequent after lesions of Meyer loop.1 Inversely, awareness after subcortical lesions may require damage to a wider network.2

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