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Because of the way things are "wired" from the eye to the brain the hemiplegic side of each visual field is blind. For example if you have a stroke on the right side of your brain that causes a left sided hemiplegia (and also presumably affects the area of the brain responsible for sight) then you would not be able to see anything to the left of whatever you are fixating on in BOTH eyes.

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This is because the right-sided stroke destroys nerve fibres that run through the right side of the brain from the right-side of each retina.

The result of losing these fibres is effectively the same as losing your right retina in both eyes --- this always results in a LEFT-sided visual field loss (left homonymous hemianopia) because the Right retinal wall of each eye sees the Left of the world because all light and images come to it through a small gap at the front of the eye (the pupil)

(ie - the right side of your retina can't see straight ahead of itself because the sclera is opaque and blocks all light - the only light that gets to the right of the retina is through the hollow pupil on its left - it can therefore only see the left of the world)

This can be seen clearly on a visual pathway diagram (Google images)

Pitfall 1 - Remember that the term "homonymous hemianopia" refers to the symptom of vision loss and not the location of where the damage occurred (eg - a L-sided homonymous hemianopia is literally LOSS OF LEFT FIELD OF VISION)

Pitfall 2 - "the homonymous hemianopia should be R-sided if the Right brain is affected" This is wrong - failure of transmission of information from the Right retina occurs but this results in a Left-sided homonymous hemianopia (as per explanation above)

Pitfall 3 - "classic stroke won't affect vision as the occipital coretx isn't affected" - this is wrong - an infarct almost anywhere along the length of a cerebral hemisphere or even the internal capsule may disrupt visual nerve fibres, as they take a long course

In summary, Right-sided stroke = Left-sided hemiparesis/plegia and Left-sided homonymous hemianopia

THE HOMONYMOUS HEMIANOPIA IS ALWAYS ON THE SAME SIDE AS THE PARESIS

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Q: What side is blind in homonymous hemianopsia the cva side or the hemiplegic side?
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