The Infant Who Keeps Turning His Face Leftwards

Kimberly G. Yen, MD; Ariel Chen


March 14, 2018

Focus on Homonymous Hemianopia

In this case, the patient presented with a face turn to compensate for a visual field loss. Although this is a less common etiology for AHP in children, it should be considered, especially when patients present with concomitant field loss or neurologic findings. Children with homonymous hemianopia may adapt by turning their head ipsilateral to the visual field defect.[10,11,12]

Paysse and Coats[10] described 10 cases where patients with early-onset homonymous hemianopia were noted to have AHP. The patients would turn their heads ipsilateral to the hemifield defect. For example, one child who suffered right cerebral hemiatrophy in utero presented with a left-sided hemianopia, left-face turn, and right-gaze preference. The researchers hypothesized that children adopt this head posture because when they turn their head toward the hemifield defect, they are able to have an expanded view of the deficient side of their field using large saccades.[10]

Other studies[11,12,13] have found that in addition to the ipsilateral face turn toward the visual field defect, children can also develop ipsilateral exotropia. Donahue and Haun[13] hypothesized that, similar to how a face turn ipsilateral to the visual field defect expands the visual field, an ipsilateral exotropia also expands the visual field.

Kedar and colleagues[14] examined pediatric homonymous hemianopias due to traumatic brain injuries, tumor, infarction, and cerebral hemorrhages. In 31 pediatric patients who had formal follow-up visual fields conducted, 39% experienced improvements over time.[14]

Although an uncommon condition, visual field loss should be considered in pediatric patients who present with a face turn. Children with AHP and visual field loss should be further evaluated with imaging to look for injuries, tumor, infarction, or hemorrhage. Patients with field loss may be able to recover some of their deficits over time.

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