Relationship between visual field defect and arterial occlusion in the posterior cerebral circulation

(1) The extent and severity of visual field loss has been compared in a series of 14 patients with occlusions of the posterior cerebral artery or its branches, all verified angiographically. Atheroma, embolism, and migraine were the commonest types of underlying vascular disease. (2) Occlusion of the main trunk of the artery was associated with severe and permanent field loss usually with some sparing of the central area and, in one case, of some field adjacent to the vertical meridian. It is suggested that this is due to collateral blood flow reaching the margins of the posterior cerebral territory from the adjacent middle cerebral territory via pial anastomoses. (3) Single or multiple occlusions of the main branches of the posterior cerebral artery gave variable amounts of field loss with considerable recovery in some cases. Collateral blood flow from the middle cerebral territory and from other branches of the posterior cerebral artery was demonstrated and the variation may be due to the size and number of pial anastomoses and to systemic factors such as blood pressure and vascular reactivity. (4) Occlusion of smaller branches of the calcarine artery produced localized zones of capillary underperfusion near the posterior cerebral pole. These corresponded to scotomatous paracentral defects in the visual field which were often permanent and showed no central sparing. The potential capacity of the collateral system may be limited by occlusion of intracerebral arteries or by involvement of segments of the pial arteries in the disease process.