Teaching NeuroImages: Evolving trans-synaptic degeneration of retinal ganglion cells after occipital lobe stroke

A 59-year-old woman presented with acute left-sided visual field loss. A left homonymous hemianopia without a relative afferent pupillary defect and corresponding right occipital stroke on MRI were noted (figure). Optical coherence tomography of the macular retinal ganglion cell complex (GCC) showed GCC loss corresponding to the area of visual field loss in the left eye first, 100 days later (figure). The left eye was affected earlier and to a greater degree, which is consistent with previous animal studies,¹ and may be due to the larger temporal visual field and larger number of crossing fibers.²