The asymmetrical visual evoked potential to pattern reversal in one half field and its significance for the analysis of visual field defects

Abstract

The consistency of the major positive component (P100) of the full-field pattern-reversal response provides a clinically valuable and objective means of detecting visual field defects. Its normally symmetrical distribution about the midline of the occipital scalp results from the summation of two highly asymmetric half-field responses, each of which shows the positive component well lateralised with a widespread distribution on the ipsilateral side. Stimulation of each eye in patients with bitemporal and homonymous hemianopias results in two characteristic patterns of asymmetry, named 'crossed' and 'uncrossed' respectively, in which the major positivity is consistently recorded on the side ipsilateral to the preserved half field. Recordings from a patient after occipital lobectomy confirm the authors' previous suggestion that although the major positive component is recorded from the ipsilateral scalp the typical asymmetric half-field response is generated in the contralateral hemisphere.