Visual input reaches the primary visual cortex (V1) at the stria of Gennari, a band of highly myelinated fibers at the level of layer IV. Damage to the visual pathways can cause visual field defects (scotomas) that prevent visual input from reaching V1. Here, we evaluate whether the stria of Gennari degrades in the absence of visual input. Using 7 Tesla MRI, we investigate the integrity of the stria of Gennari in case of acquired homonymous visual field defects, in particular hemianopia: the loss of vision in half of the visual field. These visual field defects allow us to compare stria of Gennari integrity between the two hemispheres within the same participant, i.e., the hemisphere that is deprived of visual input (affected hemisphere) versus the hemisphere receiving visual information (unaffected hemisphere). Therefore, we focus on cases of acquired blindness following damage between the optic chiasm and V1. We quantify the stria of Gennari integrity both by measuring the T1-weighted intensity at the middle of cortical depth and using a modeling approach that captures T1-weighted intensity variations across cortical depth. Our results show that the stria of Gennari remains intact in both the affected and unaffected hemisphere, suggesting that the stria of Gennari integrity is not altered in the absence of visual input.

Visual disturbances are a common presenting complaint in neurology, and the characteristics of these complaints combined with the examination findings are important in localization and then the generation of a complete differential diagnosis. Patients with diabetes, particularly in the setting of hyperglycemia, can have multiple reasons for vision changes localized throughout the visual pathways, including ophthalmic manifestations such as diabetic retinopathy, early development of nuclear sclerotic cataracts, and macular edema, as well as increased risk of ischemic optic neuropathies and retrochiasmal ischemia. Assessing the visual fields of these patients is crucial in localizing the abnormality. Occipital cortical lesions causing contralateral homonymous hemianopic visual field defects can result from a wide variety of underlying etiologies, including ischemia, mass effect, demyelination, and inflammation/infection, as well as electroclinical seizures. In addition, homonymous hemianopic visual field defects have been attributed both to direct manifestations of hyperglycemia and to hyperglycemic-induced electroclinical seizures with both ictal and postictal visual changes. We describe a patient with both bilateral homonymous visual field defects and fluctuating positive visual phenomena in the setting of poorly controlled diabetes mellitus. This case highlights the importance of localization of visual field defects and allows readers to generate a complete differential diagnosis and arrive at the most likely pathophysiology and diagnoses.

Dermoid cysts are rare, benign congenital tumors arising from ectodermal remnants that become trapped during neural tube closure. They frequently occur in midline structures such as the sellar region, where proximity to critical neurovascular structures creates diagnostic and surgical challenges. Craniopharyngiomas, in contrast, are benign epithelial tumors originating from Rathke's pouch remnants, and patients often present with visual deficits, panhypopituitarism, and hydrocephalus. We report the case of a 13-year-old female patient with progressive vision loss whose initial imaging suggested a craniopharyngioma but whose definitive pathology revealed a dermoid cyst. The patient presented with superior temporal quadrantanopia in the right eye and temporal hemianopia in the left eye. Magnetic resonance imaging (MRI) demonstrated a lesion in the sellar region extending into the suprasellar space. Surgical resection was performed through a right frontotemporal craniotomy, and complete resection was achieved. Although the clinical and radiological features suggested a craniopharyngioma, the lesion proved to be an atypical dermoid cyst. The patient remained neurologically stable postoperatively, with persistent visual impairment attributable to irreversible damage caused by tumor compression. Dermoid cysts in the sellar region may mimic craniopharyngiomas. Accurate diagnosis and careful surgical planning are essential given the proximity of these lesions to critical neurovascular structures. This case highlights the diagnostic overlap between dermoid cysts and adamantinomatous craniopharyngiomas in the pediatric population and the importance of establishing the correct diagnosis before surgery.

Background/Objectives: Visual impairment is an underrecognized but functionally disabling complication of stroke that adversely affects rehabilitation potential, autonomy, and quality of life. Clinical, anatomical, and ophthalmologic determinants of post-stroke visual recovery remain incompletely defined, particularly in Eastern European tertiary stroke units where structured visual follow-up is not standardized. This study aimed to identify clinical, imaging, and ophthalmologic predictors of favorable visual recovery and to evaluate whether integrating these domains improves early prognostic stratification beyond standard neurological assessment. Methods: We conducted a retrospective single-center cohort study of 71 consecutive adult patients admitted with acute stroke and a documented visual complication between January 2022 and September 2025 at Pius Brinzeu Emergency County Hospital and Victor Babes University of Medicine and Pharmacy Timisoara. Favorable recovery was defined as ≥50% improvement in visual field index (VFI) at 6 months. Group comparisons used Student's t-test, Mann-Whitney U test, chi-square test, and Fisher's exact test. Multivariable logistic regression, Cox proportional hazards modeling, and unsupervised k-means clustering were performed. Results: Twenty-nine patients (40.8%) achieved favorable recovery, while 42 (59.2%) had persistent impairment. Responders were younger (62.8 ± 10.7 vs. 70.4 ± 10.8 years, p = 0.005) and had lower admission National Institutes of Health Stroke Scale (NIHSS) (6.4 ± 2.9 vs. 10.3 ± 4.4, p < 0.001), smaller lesion volumes (18.7 ± 11.4 vs. 33.2 ± 18.7 mL, p < 0.001), thicker peripapillary retinal nerve fiber layer (89.3 ± 7.6 vs. 78.2 ± 9.4 μm, p < 0.001), and earlier rehabilitation initiation (11.4 ± 5.3 vs. 21.7 ± 9.8 days, p < 0.001). NIHSS, time to rehabilitation, and optical coherence tomography (OCT) pRNFL thickness remained independent predictors. The full integrated model achieved an area under the receiver operating characteristic curve (AUC) of 0.87. Cluster analysis identified three distinct phenotypes with favorable recovery rates of 79.2%, 34.8%, and 8.3%. Conclusions: Combined clinical, neuroimaging, and ophthalmologic profiling-particularly OCT pRNFL-meaningfully refines early prediction of post-stroke visual recovery and supports phenotype-driven rehabilitation planning.