Eleni Papageorgiou
University of Tübingen
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Featured researches published by Eleni Papageorgiou.
Investigative Ophthalmology & Visual Science | 2010
Ulrich Schiefer; Eleni Papageorgiou; Pamela A. Sample; John P. Pascual; B. Selig; E. Krapp; J. Paetzold
PURPOSE To assess the spatial distribution of glaucomatous visual field defects (VFDs) obtained with regionally condensed stimulus arrangements. METHODS Sixty-three eyes of 63 glaucoma subjects were examined with threshold-estimating automated static perimetry (full threshold 4-2-1 dB strategy with at least three reversals) on an automatic campimeter or a full-field perimeter. Stimuli were added by the examiner to regionally enhance spatial resolution in regions that were suspicious for a glaucomatous VFD. These regions were characterized by contiguous local VFDs, attributable to the retinal nerve fiber bundle course according to the impression of the examiner. The added stimulus locations were subsets of a predefined, dense perimetric grid. All VFD locations with P < 0.05 (total deviation plots) were assessed by superimposing the visual field records of all participants. RESULTS Glaucomatous VFD loss occurred more frequently in the upper than in the lower hemifield, with a typical retinal nerve fiber-related pattern and a preference of the nasal step region. More than 50% of the eyes with predominantly mild to moderate glaucomatous field loss showed defective locations in the immediate superior paracentral region within an eccentricity of 3°. CONCLUSIONS Conventional thresholding white-on-white perimetry with regionally enhanced spatial resolution reveals that glaucomatous visual field loss affects the immediate paracentral area, especially the upper hemifield, in many eyes with only mild to moderate glaucomatous visual field loss. Detailed knowledge about the spatial pattern and the local frequency distribution of glaucomatous VFDs is an essential prerequisite for creating regionally condensed stimulus arrangements for adequate detection and follow-up of functional glaucomatous damage.
Neurology | 2008
Eleni Papageorgiou; Luca Francesco Ticini; Gregor Hardiess; Frank Schaeffel; H. Wiethoelter; Hanspeter A. Mallot; S. Bahlo; B. Wilhelm; Reinhard Vonthein; Ulrich Schiefer; Hans-Otto Karnath
Objective: The anatomy of the human pupillary light reflex (PLR) pathway is a matter of debate. The aim of this study was twofold: namely, to investigate the association of a relative afferent pupillary defect (RAPD) in acquired suprageniculate lesions with the location and extent of the cerebral lesions. Further, we suggest a new strategy of lesion analysis by combining established techniques with the stereotaxic probabilistic cytoarchitectonic atlas developed by the Jülich group. Methods: Twenty-three patients with homonymous visual field defects participated in this study. The RAPD was quantified clinically by two independent examiners with graded neutral density filters (swinging flashlight test). Using MRI in each individual, cerebral regions commonly affected in patients with a RAPD but spared in patients without a RAPD were determined and subsequently assessed by using cytoarchitectonic probabilistic maps. Results: A RAPD was present in 10/23 patients. Comparison of patients showing a RAPD vs those not showing a RAPD revealed that a region including the course of the optic radiation at its early beginning in the temporal white matter is commonly associated with a RAPD. Conclusions: It was demonstrated that the pupillary light reflex (PLR) depends on the input of suprageniculate neurons, thus supporting the involvement of a cortical pathway also. The site of integration of cortical signals in relation to the PLR into the pupillomotor pathway may be located suprageniculately in the vicinity of the lateral geniculate nucleus. Moreover, the suggested combination of established lesion analysis techniques with the probabilistic cytoarchitectonic atlas turned out to be a very helpful amelioration of stroke data analyses.
Vision Research | 2012
Eleni Papageorgiou; Gregor Hardiess; Hermann Ackermann; H. Wiethoelter; Klaus Dietz; Hanspeter A. Mallot; Ulrich Schiefer
The aim of the present study was to examine the effect of homonymous visual field defects (HVFDs) on collision avoidance of dynamic obstacles at an intersection under virtual reality (VR) conditions. Overall performance was quantitatively assessed as the number of collisions at a virtual intersection at two difficulty levels. HVFDs were assessed by binocular semi-automated kinetic perimetry within the 90° visual field, stimulus III4e and the area of sparing within the affected hemifield (A-SPAR in deg(2)) was calculated. The effect of A-SPAR, age, gender, side of brain lesion, time since brain lesion and presence of macular sparing on the number of collisions, as well as performance over time were investigated. Thirty patients (10 female, 20 male, age range: 19-71 years) with HVFDs due to unilateral vascular brain lesions and 30 group-age-matched subjects with normal visual fields were examined. The mean number of collisions was higher for patients and in the more difficult level they experienced more collisions with vehicles approaching from the blind side than the seeing side. Lower A-SPAR and increasing age were associated with decreasing performance. However, in agreement with previous studies, wide variability in performance among patients with identical visual field defects was observed and performance of some patients was similar to that of normal subjects. Both patients and healthy subjects displayed equal improvement of performance over time in the more difficult level. In conclusion, our results suggest that visual-field related parameters per se are inadequate in predicting successful collision avoidance. Individualized approaches which also consider compensatory strategies by means of eye and head movements should be introduced.
Acta Ophthalmologica | 2012
Eleni Papageorgiou; Gregor Hardiess; Horst Wiethölter; Hermann Ackermann; Klaus Dietz; Hanspeter A. Mallot; Ulrich Schiefer
Purpose: The aim of this study was to assess the brain regions associated with impaired performance in a virtual, dynamic collision avoidance task, in a group of patients with homonymous visual field defects (HVFDs) because of unilateral vascular brain lesions.
Journal of Neuro-ophthalmology | 2009
Eleni Papageorgiou; Thomas Wermund; Helmut Wilhelm
Background: Lesions affecting the pretectum or the brachium of the superior colliculus (brachium) and sparing the optic tract cause a contralateral relative afferent pupil defect (RAPD) but no visual field loss. It has been assumed that the pupillomotor pathways within the brachium are a continuation of the pupillomotor pathways traveling in the optic tract. To investigate this assumption, we looked for hemihypokinesia by means of pupil perimetry. Methods: Pupillary hemifield stimulation was performed in a 65-year-old woman with normal visual fields and an isolated left RAPD due to a cerebral hemorrhage affecting the right dorsal midbrain. The pupil responses from light stimulation of the nasal inferior, nasal superior, and temporal inferior and temporal superior quadrants of both eyes were recorded using computerized binocular infrared pupillography. Each stimulus was presented 5 times and the mean amplitude of the pupil response was calculated for each stimulus location. Results: Pupil perimetry demonstrated a marked hemihypokinesia (reduced light reaction) in the hemifield contralateral to the site of the lesion. Conclusions: Our experiment suggests that the brachium is indeed a continuation of the afferent pupillary fibers traveling in the optic tract.
Graefes Archive for Clinical and Experimental Ophthalmology | 2012
Martin Ganssauge; Eleni Papageorgiou; Ulrich Schiefer
BackgroundThe aim of this work is to investigate the facial distortion (dysmorphopsia) experienced by patients with homonymous paracentral scotomas and to analyze the interrelationship with the previously described “thin man” phenomenon.MethodsRoutine neuro-ophthalmological examination and brain MRI in three patients who suffered from small homonymous paracentral scotomas due to infarction or arteriovenous malformations of the occipital lobe. They all complained of distortion and shrinkage of their interlocutor’s face contralateral to the brain lesion. The phenomenon appeared some seconds after steady fixation on the interlocutor’s nose and was evident with both left and right homonymous scotomas. The patients did not notice a gap in the area corresponding to the scotoma and objects other than faces were perceived normally.ResultsHomonymous paracentral scotomas can lead to focal displacement of facial features towards the center of the field defect with resulting distortion of the face on the affected side. This so-called “dysmorphopsia” makes faces appear regionally narrower than they are in reality and may be induced even by visual field defects that remain undetected by conventional perimetry using 6° × 6° grids. Predilection for faces is probably associated with the superior location of scotomas or specific impairment of face processing abilities related to the lesion site.ConclusionsFacial dysmorphopsia is most probably associated with cortical “filling-in” and spatial distortion, and can hence be regarded as a special entity of the “thin man” phenomenon.
Case Reports in Ophthalmology | 2012
Eleni Papageorgiou; Spyridon Karamagkiolis; Vasiliki Dimera
We report the first case of nonarteritic anterior ischemic neuropathy (NAION) associated with double thrombophilia: protein S deficiency and prothrombin G20210A mutation. A 58-year-old man is presented including the clinical and laboratory findings, cardiovascular profile and thrombophilia screening. The patient presented with 3/10 vision and an inferior altitudinal defect in the right eye. Funduscopic examination of the right eye revealed a hyperemic optic disk with blurred superior optic disk border and sectoral nerve fiber layer edema. Complete blood count, erythrocyte sedimentation rate and C-reactive protein were normal, suggesting a NAION. A workup of cardiovascular risk factors revealed hyperlipidemia, arterial hypertension and high-risk asymptomatic coronary artery disease. Due to the family history of deep vein thrombosis in the patient’s daughter, a thrombophilia screening was additionally performed. The results revealed a double thrombophilic defect, namely congenital protein S deficiency and heterozygosity for prothrombin G20210A mutation, which were also identified in the patient’s daughter. Anticoagulant warfarin therapy was initiated and the patient underwent a triple bypass surgery. At three-month follow-up, the right optic disk edema had resolved, leaving a pale superior optic nerve head. Visual acuity in the right eye had slightly improved to 4/10; however, the dense inferior altitudinal field defect had remained unchanged. The patient is currently treated with warfarin, atorvastatin, irbesartan and metoprolol. This case suggests that the first line of investigation in all patients with NAION involves assessment of cardiovascular risk factors. However, careful history taking will identify NAION patients who are eligible for additional thrombophilia screening: young patients without vasculopathic risk factors, bilateral or recurrent NAION, idiopathic or recurrent venous thromboembolism (VTE), positive family history of VTE, and VTE in young age or in unusual sites (e.g. cerebral, hepatic, mesenteric, or renal vein).
Journal of Neuro-ophthalmology | 2012
Eleni Papageorgiou; Luca Francesco Ticini; Ulrich Schiefer
Background Peripheral homonymous scotomas beyond 30° from fixation are rare. The paucity of publications describing such visual field defects might be attributed to various factors, including the absence of severe symptoms, routine visual field assessment restricted to the central 30° with automated perimetry, and the collateral circulation to the occipital cortex. The aim of this study was to correlate the brain lesions and perimetric findings in 2 unusual cases of peripheral homonymous scotomas, with the anatomic location of the optic radiation and primary visual cortex. Methods Two patients with circumscribed homonymous scotomas beyond 30° related to infarcts in the intermediate area of the visual cortex are reported. We describe a new strategy, which relies on modern lesion analysis and stereotaxic probabilistic cytoarchitectonic maps, to accurately correlate the brain lesion site with the location of the peripheral homonymous visual field defects. Results In Case 1, the posterior optic radiation was affected in its termination in the upper intermediate visual cortex. In Case 2, the lesion was located in the upper rostral portion of the primary visual cortex. In both, the most anterior part of the visual cortex and the occipital pole were intact, accounting for preservation of the central and most peripheral visual field. Additionally, correlation of the neuroimaging findings with commonly used maps of the representation of the visual field on the striate cortex suggested that our data were most consistent with the Holmes map. Conclusions Modern lesion analysis and cytoarchitectonic maps, in combination with the existing retinotopic maps, may provide reliable clues for the localization of cerebral infarction and prognosis of homonymous visual field defects and may lead to a better understanding of the link between neuroanatomical landmarks and functional outcomes.
Ophthalmologe | 2007
Eleni Papageorgiou; Ulrich Schiefer; M. Warmuth-Metz; P. Weckerle
ZusammenfassungDie Morning-glory-Papille (MGP) ist eine seltene, angeborene Sehnervanomalie, die mit Fehlbildungen in den kraniofazialen Mittellinienstrukturen wie basalen Enzephalozelen einhergehen kann. Ein weiblicher Säugling wurde mit MGP am rechten Auge, Pendelnystagmus, Hypertelorismus, eingesunkener Nasenwurzel und Lippen- und Kieferspalte vorstellig. Das MRI zeigte eine basale Enzephalozele, eine Balkenagenesie und eine Ventrikelvergrößerung. Eine MGP bei medianen fazialen Spalten sollte immer den Verdacht auf eine basale Enzephalozele lenken.AbstractMorning glory disc anomaly (MGDA) is a rare congenital malformation of the optic disc, which can be associated with midline craniofacial abnormalities, such as basal encephalocele. A female neonate presented with MGDA in the right eye, pendular nystagmus, hypertelorism, a flattened nasal root and cleft lip and palate. MRI revealed a basal encephalocele, agenesis of the corpus callosum and ventricular enlargement. MGDA combined with midline facial clefting should always lead to the suspicion of a basal encephalocele.
Ophthalmologe | 2007
Eleni Papageorgiou; Ulrich Schiefer; M. Warmuth-Metz; P. Weckerle
ZusammenfassungDie Morning-glory-Papille (MGP) ist eine seltene, angeborene Sehnervanomalie, die mit Fehlbildungen in den kraniofazialen Mittellinienstrukturen wie basalen Enzephalozelen einhergehen kann. Ein weiblicher Säugling wurde mit MGP am rechten Auge, Pendelnystagmus, Hypertelorismus, eingesunkener Nasenwurzel und Lippen- und Kieferspalte vorstellig. Das MRI zeigte eine basale Enzephalozele, eine Balkenagenesie und eine Ventrikelvergrößerung. Eine MGP bei medianen fazialen Spalten sollte immer den Verdacht auf eine basale Enzephalozele lenken.AbstractMorning glory disc anomaly (MGDA) is a rare congenital malformation of the optic disc, which can be associated with midline craniofacial abnormalities, such as basal encephalocele. A female neonate presented with MGDA in the right eye, pendular nystagmus, hypertelorism, a flattened nasal root and cleft lip and palate. MRI revealed a basal encephalocele, agenesis of the corpus callosum and ventricular enlargement. MGDA combined with midline facial clefting should always lead to the suspicion of a basal encephalocele.