title: Homonymous field defect as the first manifestation of Creutzfeldt-Jakob disease.
abstract: OBJECTIVE
  Although in the early stage of Creutzfeldt-Jakob disease most patients have obvious dementia, we found that the disease can be diagnosed in patients solely on the basis of a visual system disorder.
  
  
  METHODS
  We examined three patients who initially complained of a nonspecific, insidious visual disturbance.
  
  
  RESULTS
  The three patients were found to have Creutzfeldt-Jakob disease, confirmed by histopathologic analysis. Each patient had a homonymous hemianopsia on the first neuro-ophthalmologic examination. The initial neurologic, neuroimaging, and electrophysiologic examinations were not conclusive. The subsequent rapid deterioration in the neurologic status, including dementia and typical electroencephalographic changes, was suggestive of Creutzfeldt-Jakob disease.
  
  
  CONCLUSIONS
  At onset of Creutzfeldt-Jakob disease, patients may have a homonymous hemianopsia despite normal results of magnetic resonance imaging of the brain and neurologic examination.
authors.affiliation: Department of Ophthalmology, New York University Medical Center, New York, USA.
authors.forename: M E
authors.initials: ME
authors.lastname: Vargas
authors.forename: M J
authors.initials: MJ
authors.lastname: Kupersmith
authors.forename: P J
authors.initials: PJ
authors.lastname: Savino
authors.forename: F
authors.initials: F
authors.lastname: Petito
authors.forename: L P
authors.initials: LP
authors.lastname: Frohman
authors.forename: F A
authors.initials: FA
authors.lastname: Warren
mesh_terms: D000368:Aged; D001706:Biopsy; D001921:Brain / Q000473:pathology; D007562:Creutzfeldt-Jakob Syndrome / Q000150:complications / Q000175:diagnosis*; D004569:Electroencephalography; D006423:Hemianopsia / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D058609:Visual Field Tests; D014794:Visual Fields