DOCSLIB.ORG

Print This Article

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Print This Article University Journal of Surgery and Surgical Specialities ISSN 2455-2860 2020, Vol. 6(2) 2 CASE REPORTS OF OPTIC CHIASMAL SYNDROME BAVYA M Department of Ophthalmology, MADRAS MEDICAL COLLEGE AND GOVERNMENT GENERAL HOSPITAL Abstract : The optic chiasm is one of the most important Anterior segment examination of the right eye was normal. Right structures in neuro ophthalmologic diagnosis. The eye showed sluggish pupillary reaction to light. Fundus of right arrangement of visual fibres in the chiasm accounts for eye showed disc edema with peripapillary hemaorrhages[FIG 1]. characteristic defects in the visual fields caused by such Left eye vision was 3/60 which improved to 6/36 with correction. diverse processes as compression , inflammation , Left eye showed sluggish pupillary reaction to light. Otherwise demyelination, ischemia and infiltration. Two cases are anterior segment was normal. Fundus showed disc edema with a presented here. The first case presented with right temporal haemorrhage in the superotemporal quadrant[FIG 2]. Both eyes field defect with central scotoma of the left eye and bilateral showed lens changes. papilledema. MRI SCAN showed it as suprasellar astrocytoma. The second case presented with temporal field defect and left eye optic atrophy. MRI SCAN showed it as pituitary macro adenoma or dorsal sella meningioma. Thus showing the importance of ocular examination in identifying intracranial tumours. Keyword :Optic chiasm, temporal field defect, papilledema, optic atrophy INTRODUCTION The optic chiasm is one of the most important structure in FIG 1: Right Eye papilledema neuro-ophthalmologic diagnosis. Damage to the optic chiasm can occur from direct or indirect effects of a variety of lesions. Some of them are pituitary adenomas, suprasellar meningiomas, craniopharyngiomas, gliomas and aneurysms originating from the internal carotid artery. During pregnancy pituitary adenomas become symptomatic. It enlarges resulting in compression of the chiasma and resulting visual defects. Secondary empty sella can be associated with chiasmal syndrome. It can follow surgeries involving removal of suprasellar meningiomas and craniopharyngiomas. optic FIG 2:Left Eye Papilledema chiasmal syndromes present with the characteristic field Automated perimetry of both eyes were performed. Right eye defects with papilledema, optic atrophy or sea saw showed absolute defects in the temporal field[FIG 3,5]. Left eye nystagmus. showed absolute defects in the fixation area[FIG 4,6]. MRI Scan CASE 1: revealed a well enhancing suprasellar mass lesion compressing A 56 year female came with complaints of defective vision in left optic nerve and optic chiasma – displacing it superiorly and the left eye and field defect in the left temporal region and causing erosion of the underlying dorsum sellae and obstructive right temporal region for the past 20 days. History of dilation of the lateral and fourth ventricles and compression of headache for the past 15 years which increased in intensity the third ventricle. Features were suggestive of suprasellar for the past 20 days, was associated with vomiting. She was astrocytoma[FIG 7] Neurosurgery opinion was obtained and the not a known case of diabetes mellitus, hypertension. She patient is planned for craniotomy It is a case of optic chiasmal attaine menopause at 50 years of age. On examination right syndrome with bilateral papilloedema eye vision was 6/36 which improved to 6/24 with correction. An Initiative of The Tamil Nadu Dr. M.G.R. Medical University University Journal of Surgery and Surgical Specialities temporal pallor [FIG 8] while left eye showed primary optic atrophy [FIG 9]. FIG 3: Field Chart Of Right Eye enlarged view FIG 8: Fundus showing temporal pallor in Right eye FIG 9: Fundus showing optic atrophy of Left eye FIG 4: Field Chart of Left Eye enlarged view Automated perimetry showed absolute field defects in temporal region in the right eye [FIG 10]. Left eye automated perimetry could not be done due to poor vision FIG 5: Field Chart Of Right Eye FIG 10: Field chart of Right eye FIG 11: MRI BRAIN FIG 6: Field Chart of Left Eye MRI Brain with contrast showed a well-defined T1 isointense T2 Flair hyperintense mass lesion measuring 3x2.72cm noted arising from sella extending to suprasellar region .The lesion causing compression of bilateral optic nerves .Features were suggestive of pituitary macroadenoma / dorsal sella meningioma [FIG 11] Patient was referred for physician opinion and neurosurgery department It was diagnosed as a case of optic chiasmal syndrome with left eye primary optic atrophy. FIG 7: MRI BRAIN DISCUSSION: MRI Scan revealed a well enhancing suprasellar mass lesion Chiasmal syndrome is the set of signs and symptoms that compressing left optic nerve and optic chiasma – displacing it are associated with lesions of the optic chiasm manifesting superiorly and causing erosion of the underlying dorsum sellae and as various impairments of the visual field according to the obstructive dilation of the lateral and fourth ventricles and location of the lesion along the optic nerve It can be compression of the third ventricle. divided into anterior, middle and posterior locations The CASE 2: classic anterior chiasmal lesion affects the optic nerve A 46 year old female patient came with complaints of defective fibers and the contralateral inferonasal fibers located in vision left eye since 3 months. She had no history of headache or Willebrand’s knee. This will produce an ipsilateral optic vomiting .Not a known case of diabetes mellitus, hypertension. She neuropathy, often manifested as a central scotoma , and a attained menopause at 45 years of age. On ocular examination right defect involving the contralateral superotemporal field. eye had a vision of 6/18. Anterior segment was normal. Left eye This is also known as a junctional scotoma. Middle lesions had a vision of 1/60. Left eye pupil showed relative afferent pupillary affecting the uncrossed temporal fibers are rare. These defect. Both eyes showed lens changes. Right eye fundus showed can result in a nasal or binasal hemianopia. Lesions in the body of the chiasm most commonly disrupt the crossing An Initiative of The Tamil Nadu Dr. M.G.R. Medical University University Journal of Surgery and Surgical Specialities nasal retinal fibers. This leads to a bitemporal hemianopia. The field have affected the body of the chiasm. A posterior chiasm of vision may still be full when both eyes are open but stereovision lesion should produce defects on the temporal sides of the will not be possible. Because macular fibers cross more posteriorly central visual field. The patients are managed according to in the chiasm, they are damaged in posterior chiasmal syndrome. the etiology. This leads to a smaller, paracentral bitemporal field loss. Because CONCLUSION the temporal macular fibers have not been damaged, it is possible to Chiasmal syndrome can present with papilledema or optic preserve color vision and visual acuity. Posterior lesions may also atrophy depending on the etiology. Pituitary adenomas involve the optic tract and cause a contralateral homonymous rarely cause papilledema. These two cases emphasize the hemianopia. Optic disc pallor may be apparent with an importance of ocular examination in detecting tumors ophthalmoscope if the result is longstanding. If the lesion does not involving the chiasma affect the lateral uncrossed fibers , the pallor may take on a bow-tie References: configuration. This is due to loss of retinal ganglion cells nasal to the 1.Foroozan R. Chiasmal syndromes. Current opinion in macula in the papillomacular bundle. Compressive lesions often ophthalmology. 2003 Dec 1;14(6):325-31. cause headache and may compress the third ventricle leading to 2. Cushing H. The chiasmal syndrome: of primary optic papilledema. More commonly associated with suprachiasmal lesions atrophy and bitemporal field defects in adults with a invade or compress the third ventricle. The etiologies of chiasmal normal sella turcica. Archives of Ophthalmology. 1930 syndromes can be intrinsic and extrinsic causes. Intrinsic implies May 1;3(5):505-51. thickening of the chiasm itself and extrinsic implies compression by 3. Mejico LJ, Miller NR, Dong LM. Clinical features another structure. Other less common causes of chiasmal syndrome associated with lesions other than pituitary adenoma in are metabolic, toxic, traumatic or infectious in nature. Intrinsic patients with an optic chiasmal syndrome. American etiologies include gliomas and multiple sclerosis. Gliomas of the journal of ophthalmology. 2004 May 31;137(5):908-13. optic chiasm are usually derived from astrocytes. These tumors are 4. WAGENER HP, CUSICK PL. Chiasmal syndromes slow growing and more often found children. However, they have a produced by lesions in the posterior fossa. Archives of worse prognosis, especially if they have extended into the Ophthalmology. 1937 Dec 1;18(6):887-91. hypothalamus. They are frequently associated with 5. Levin LA. Topical diagnosis of chiasmal and neurofibromatosis type 1 (NF-1). Their treatment involves the retrochiasmal disorders. Walsh and Hoyt clinical resection of the optic nerve. The supposed artifactual nature of neuro-ophthalmology, 6th ed. Baltimore: Williams & Willebrand's knee has implications for the degree of resection that Wilkins. 2005:503-73. can be obtained, namely by cutting the optic nerve immediately at 6. Savino PJ, Glaser JS, Schatz NJ. Traumatic chiasmal the junction with the chiasm without fear of potentially resulting syndrome. Neurology. 1980 Sep 1;30(9):963-. visual field deficits. The vast majority of chiasmal syndromes are compressive. There are several compressive etiologies, the usual suspects are pituitary adenomas ,craniopharyngiomas and meningiomas. Pituitary tumors are the most common cause of chiasmal syndromes. Visual field defects may be one of the first signs of non-functional pituitary tumor. These are much less frequent than functional adenomas. Systemic hormonal aberrations such as cushing's syndrome, galactorrhea and acromegaly usually predate the compressive signs. Pituitary tumors often encroach upon the middle chiasm from below. Pituitary apoplexy is one of the few acute chiasmal syndromes.
Load more

Recommended publications
  • Pituitary Adenomas and Ophthalmology
    1 Pituitary Adenomas and Ophthalmology Santiago Ortiz-Perez and Bernardo Sanchez-Dalmau Hospital Clinic, University of de Barcelona, Ophthalmology department Spain 1. Introduction Pituitary gland, also called hypophysis, is a neuroendocrine organ placed in the “sella turcica” in the skull base. This gland consists of 2 main areas, the anterior and medial part constitute the adenohypophysis, the posterior part is called neurohypophysis. Pituitary gland is in charge of the internal constancy, homeostasis and reproductive function; this is why pituitary abnormalities cause a wide spectrum of signs and symptoms. Pituitary adenomas are a common pathology; they represent about 10% of all intracranial tumours and between 50-80% of pituitary tumours. Necropsy and imaging studies estimate an incident of 20-25% of pituitary adenomas in general population; however, only about 1/3 of them are clinically evident (Asa & Ezzat, 2009). The majority of these tumours have monoclonal origin (mutation of a single gonadotropic cell), but there are still some discrepancies about the pathogenesis of these neoplasms. The most common mutations seem in other human neoplasms are not frequent in pituitary adenomas, and only a minimum proportion of them are associated to other genetic disorders, such as MEN1 syndrome (multiple endocrine neoplasms type 1) or the Carney complex, due to mutations of the genes MEN1 and PRKAR1A (protein kinase A regulatory subunit 1A) respectively (Beckers & Daly, 2007). Hormones and growth factors involve in normal pituitary function can be also related to the growth of these tumours, although evident connection with the pathogenesis has not been demonstrated. Symptoms related to pituitary tumours are secondary to several factors.
    [Show full text]
  • Traumatic Disruption of the Optic Chiasm
    PHOTO ESSAY Traumatic Disruption of the Optic Chiasm Laura Segal, MDCM, Jella Angela An, MDCM, and Mark Gans, MDCM, FRCSC FIG. 1. A. Goldmann visual field examination demonstrates complete bitemporal hemianopia. B. T2 coronal MRI performed on the day of the accident reveals enlargement and distortion of the optic chiasm, with high signal mostly on the left side due to intrinsic hemorrhage (arrow). C. T2 coronal MRI performed 4 weeks after the accident reveals thickening and distortion of the chiasm and complete transection on the left side (arrow). Abstract: A 27-year-old man developed a persistent (J Neuro-Ophthalmol 2009;29:308–310) bitemporal hemianopia after severe head trauma sustained in a high-speed motor vehicle accident. The 27-year-old male pedestrian was hit by a car while he initial brain MRI revealed hemorrhagic contusion of Awas crossing the highway. The initial Glasgow Coma the optic chiasm. A brain MRI performed 4 weeks Scale score was 8 with reactive pupils bilaterally. Non- later demonstrated complete chiasmal transection, contrast brain CT revealed multiple bilateral orbital wall a phenomenon rarely documented with imaging. and facial fractures including the sphenoid walls, but there was no evidence of muscle entrapment or optic nerve sheath pathologic changes. McGill University Health Centre, Montreal, Quebec, Canada. Address correspondence to Laura Segal, MDCM, Montreal General Full ophthalmologic examination performed 5 days Hospital, 1650 Cedar Avenue, Montreal, QC H3G 1A4, Canada. E-mail: after the trauma disclosed a visual acuity of 20/50 in both [email protected] eyes. Pupils measured 4.5 mm in the right eye and 2.5 mm 308 J Neuro-Ophthalmol, Vol.
    [Show full text]
  • Clinical Characteristics and Ophthalmologic Findings of Pituitary
    Int Ophthalmol (2019) 39:21–31 https://doi.org/10.1007/s10792-017-0778-x (0123456789().,-volV)(0123456789().,-volV) ORIGINAL PAPER Clinical characteristics and ophthalmologic findings of pituitary adenoma in Korean patients Tae Gi Kim . Kyung Hyun Jin . Jaheon Kang Received: 11 June 2017 / Accepted: 24 November 2017 / Published online: 22 December 2017 Ó Springer Science+Business Media B.V., part of Springer Nature 2017 Abstract visual field defects was found in 36.1% of patients. Purpose To investigate the clinical characteristics of Tumor volume was positively correlated with visual and ophthalmic findings in Korean patients diagnosed field pattern standard deviation (PSD, p = 0.020) and with a pituitary adenoma. best-corrected logMAR visual acuity (p = 0.000) and Methods The medical records of 534 patients diag- negatively associated with tumor volume and visual nosed with a pituitary adenoma at Kyung Hee field mean deviation (MD, p = 0.000). Best-corrected University Hospital between January 2007 and visual acuity (p = 0.000), MD (p = 0.001), and PSD December 2016 were retrospectively reviewed. (p = 0.028) significantly improved after surgery. Results Mean patient age was 47.9 ± 16.2 years. Conclusions Pituitary adenoma patients do not The most common symptoms at the time of presen- always have ocular symptoms at their first presenta- tation were headache (26.2%) and visual disturbance tion, even when optic chiasm compression and visual (12.4%). The referral rate to the ophthalmology field deficits are present. Therefore, collaboration with department was 18.44% and patients most often an ophthalmologist is important when evaluating presented to the neurosurgery department.
    [Show full text]
  • Chiasmal and Retrochiasmal Lesions
    CHIASMAL AND RETROCHIASMAL LESIONS Dr. Krati Gupta Dr. Saurabh Deshmukh www.eyelearn.in CHIASMAL AND RETROCHIASMAL LESIONS 1. Causes and ocular manifestations of chiasmal lesions. 3+7 (J2018) 2. Draw a diagram of visual pathway and show visual defects in craniopharyngioma and occipital lobe lesion. J2013 3. Describe anatomy and lesions of optic tracts, chiasma and optic radiations. J2014 4. Define scotoma. How do you differentiate between positive and negative scotoma. Discuss the approach to diagnosis in a patient presenting with left hemianopia. J2012 (optic tract + radiation lesion on right) Chiasmal Lesions i. With the segregation of nasal and temporal retinal fibers at the chiasm, visual field loss due to chiasmal and retrochiasmal lesions is characterized by temporal defects that align along the vertical meridian. ii. In chiasmal syndromes, the optic discs may appear normal initially, even with significant visual field loss. iii. Early on, peripapillary retinal NFL dropout and mild disc pallor develop. iv. With progressive damage, the optic discs show typical atrophy, often in the temporal portion of the disc. v. Cupping of the disc may or may not increase. vi. A tumor compressing the chiasm almost never produces optic disc edema. vii. Parasellar lesions that involve the chiasm—whether compressing or infiltrating this area—produce gradually progressive, bilateral, often asymmetric vision loss. viii. The peripheral (temporal) visual fields usually are involved first. ix. In any case of bilateral visual field loss, the clinician must carefully evaluate perimetry testing results for respect of the vertical midline. x. Any of the variations on bitemporal visual field loss may occur.
    [Show full text]
  • Bitemporal Hemianopia Caused by an Intracranial Vascular Loop
    ser photocoagulation to the tumor excision and has been shown to in- cluding tumors and carotid artery surface and surrounding retina was crease patient survival.5 aneurysms1; however, reports of bi- provided. Visual acuity continued to temporal field loss from compres- decrease to 20/70 OD at 17 months, Carol L. Shields, MD sion by an abnormal vessel are rare.2 so PDT was performed (Figure). Miguel A. Materin, MD We describe a patient with a non- The entire astrocytoma was treated Brian P. Marr, MD progressive bitemporal hemiano- with a single 83-second laser spot at Jaime Krepostman, MD pia in whom there appeared to be 689 nm (50 J/cm2) following intra- Jerry A. Shields, MD compression of the optic chiasm by 2 venous verteporfin (6 mg/m ). Af- Correspondence: Dr C. L. Shields, an elongated right anterior cerebral ter treatment, resolution of macu- Ocular Oncology Service, Wills Eye artery (ACA). lar exudation, edema, and subretinal Institute, Ste 1440, 840 Walnut St, fluid led to improved vision of 20/50 Philadelphia, PA 19107 (carol Report of a Case. A bitemporal OD (at 1 month) and 20/30 OD (at [email protected]). hemianopia was found in a 65-year- 4, 8, and 12 months). The tumor Author Contributions: Dr C. L. old woman with no vascular risk fac- showed minimal involution with de- Shields had full access to all the data tors during a routine eye examina- creased intrinsic vascularity. in the study and takes responsibil- tion in 2003. Magnetic resonance ity for the integrity of the data and imaging (MRI) results were nor- Comment.
    [Show full text]
  • DEPARTMENT of OPHTHALMOLOGY FACULTY of MEDICINE UNIVERSITAS PADJAJARAN NATIONAL EYE CENTER CICENDO EYE HOSPITAL BANDUNG Case
    0 DEPARTMENT OF OPHTHALMOLOGY FACULTY OF MEDICINE UNIVERSITAS PADJAJARAN NATIONAL EYE CENTER CICENDO EYE HOSPITAL BANDUNG Case Report : Chiasmal Syndrome with Mass in Sella Turcica Presenter : Magdalena Purnama Soeprajogo Supervisor : Antonia Kartika, MD Has been reviewed and approved by Supervisor of Neuro-Ophthalmology Unit Antonia Kartika, MD Monday, September 21th 2020 08.15 AM 1 Chiasmal Syndrome with Mass in Sella Turcica Abstract Introduction Undiagnosed chiasmal syndrome come to neurosurgeons only after being misdiagnosed leads to decreased visual acuity, progression of the pathological process, and irreversible loss of sight. Purpose to describe the clinical characteristics of patients with the chiasmal syndrome . Case Report a 26 years old male with a chief complaint of blurred vision on the right eye since 2 months. Visual acuity on the right eye was 0.63 and on the left eye was 1.0. The visual field testing showed bitemporal hemianopia. OCT RNFL showed marked thinning on right eye. The brain CT scan showed homogenous enhancing mass at sellar tursica. Neurosurgeon referral was advised to patient. Result The brain CT scan showed homogenous enhancing mass at sellar tursica. Neurosurgeon referral was advised to patient. Conclusion Bitemporal hemianopia are common visual field defect in chiasmal syndrome. Neuroimaging examination is mandatory to confirm the topical diagnosis. Chiasmal syndrome early detection of by ophthalmologists and timely referral to relevant specialists will facilitate improved visual function outcomes and quality of life for patients Keywords Chiasmal syndrome, bitemporal hemianopia, sellar tursica. I. Introduction Chiasmal syndrome is the name given to the group of symptoms and signs that occur together as a result of lesions affecting the optic chiasm.
    [Show full text]
  • Isolated Lymphoma of the Optic Nerve, Chiasm and Tract: a Case Report
    ONCOLOGY LETTERS 10: 3013-3017, 2015 Isolated lymphoma of the optic nerve, chiasm and tract: A case report YUE‑LI ZHU1,2, XIU‑FENG SONG3 and BIN WANG1,4 1Shandong Medical Imaging Research Institution, Shandong University, Jinan, Shandong 250021; 2Department of Radiology, Qingdao Municipal Hospital, Qingdao, Shandong 266071; 3Department of Radiology, Qingdao University Affiliated Hospital, Qingdao, Shandong 266003; 4Medical Imaging Research Institute, Binzhou Medical University, Yantai, Shandong 264003, P.R. China Received October 16, 2014; Accepted July 17, 2015 DOI: 10.3892/ol.2015.3675 Abstract. The current study reports the case of a 68-year-old, in the immunocompetent population has been reported to have previously healthy female who presented with progressive increased >10-fold from 2.5 cases to 30 cases per 10 million visual impairment leading to blindness bilaterally. Brain population between 1973 and 1992 (2,3). The cause for the imaging features were suggestive of malignant glioma of the increase in incidence of this disease in the immunocompetent anterior visual pathway. Postoperative examination indicated population is unknown. Surgical resection is generally ineffec- a diagnosis of diffuse malignant lymphoma type B. As no tive due to the depth of the tumor. Furthermore, treatment with evidence of extracranial lymphoma was observed, the final radiotherapy and corticosteroids often only produce a partial diagnosis was primary central nervous system lymphoma response, and tumors recur in >90% of patients (4). Median (PCNSL). Following treatment with surgery and radiotherapy, survival is 10-18 months in immunocompetent patients, and the patient's symptoms went into remission. At a follow-up less in those with AIDS (5).
    [Show full text]
  • An Unusual Chiasmal Visual Defect in a Patient with Neuromyelitis Optica: Case Report
    RELATOS DE CASOS An unusual chiasmal visual defect in a patient with neuromyelitis optica: case report Comprometimento quiasmático incomum em um paciente com neuromielite óptica: relato de caso Roberta Martins da Silva Costa1 ABSTRACT Antonio Carlos Santos2 Laudo Silva Costa3 Purpose: To report the unusual visual field finding due to a chiasmal neuritis in a 33-year-old female with the diagnosis of optic neuromyelitis optica (Devic’s syndrome). Methods: We report a case of a 33 years old female with limb paraesthesias, weakness in the legs, bowel and bladder dysfunction that was referred to the “Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo” in October 1995. Six years and four months later she had an acute visual involvement. Ophthalmologic examination, laboratory studies, magnetic resonance imaging (MRI) and a 24-2 threshold visual field in the Humphrey field analyzer were performed. Results: The MRI scan showed enlargement and cavitation on the spinal cord and chiasmal involvement (thickening of the chiasm with contrast enhancement) and no demyelinating lesions in the brain, brainstem, or cerebellum. The central 24-degree threshold field examination showed an inferior visual field defect bitemporally, disclosing a chiasmal involvement. Conclusion: Chiasmal involvement may occur in neuromyelitis optica, probably due to a plaque within the chiasm. The authors call attention to the importance of visual field examination with particular regard to quantifying the visual impairment and follow-up of these patients. Keywords: Hemianopsia; Neuromyelitis optica/diagnosis; Optic chiasm; Scotoma; Perimetry; Optic neuritis INTRODUCTION Trabalho realizado no Hospital das Clínicas da Faculda- de de Medicina da Universidade de São Paulo - USP - The diagnosis of chiasmal syndrome can be divided into compressive and Ribeirão Preto (SP) - Brasil.
    [Show full text]
  • Haemorrhage from a Cavernous Malformation in the Optic Chiasm
    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.52.9.1095 on 1 September 1989. Downloaded from Journal ofNeurology, Neurosurgery, and Psychiatry 1989;52:1095-1099 Short report Chiasmal apoplexy: haemorrhage from a cavernous malformation in the optic chiasm LUCA REGLI,* NICOLAS DE TRIBOLET,* FRANCO REGLI,** JULIEN BOGOUSSLAVSKY** From the Departments ofNeurosurgery* and Neurology**, University Hospital, Lausanne, Switzerland SUMMARY We present a patient who experienced sudden onset of orbital headache, visual loss and bitemporal visual field defect. MRI of the optic chiasm suggested a diagnosis of haemorrhage and hence a vascular malformation. Pterional craniotomy revealed an intrachiasmatic haematoma with a cavernous angioma. The malformation was totally excised and vision improved after surgery. The syndrome of chiasmal apoplexy is discussed. Protected by copyright. Visual field defects due to chiasmal compression from no pupillary defect. Computerised tomography showed a a tumour usually progress slowly. An acute syndrome high-density, poorly enhanced mass in the anterior part of may be due to ischaemic, haemorrhagic or demyelin- the right optochiasmal cistern (fig 2). The carotid angiogra- iating disease. phy was normal. MRI, performed three days after onset, "Chiasmal showed enlargement of the chiasm on the right side by an apoplexy" is essentially associated with intrachiasmal lesion with a mixed hypo- and a slight hyperin- haemorrhage in the chiasm itself and is typically of tense signal, when compared with grey matter, on mildly Tl- sudden onset. We report a case of spontaneous and proton-weighted images (figs 3 and 4). haematoma in the optic chiasm from a cavernous malformation which could be suspected on magnetic Operation resonance imaging (MRI).
    [Show full text]
  • Isolated Bitemporal Hemianopsia Due to Traumatic Chiasmal Syndrome
    CASE REPORT Isolated bitemporal hemianopsia due to traumatic chiasmal syndrome Bulent Yazici, M.D., Sertac Argun Kivanc, M.D. Department of Ophthalmology, Uludağ University Faculty of Medicine, Bursa, Turkey ABSTRACT A 20-year-old man presented with complaints of inability to see the outer half of objects and blurred near vision while reading. His complaints began one year ago after a motor vehicle accident that caused cranio-orbital fractures. Ocular examination revealed com- plete bitemporal hemianopsia and slight exotropia. Central visual acuity was 20/20 in both eyes. Radiologic studies demonstrated frac- tures in the fronto-ethmoid and sphenoid bones and thinning of the optic chiasm. No hypothalamic-pituitary abnormality was detected. Clinical findings remained unchanged during follow-up. Although rare, blunt head trauma may cause an isolated damage to the chiasmal crossing nerve fibers, resulting in a complete, bitemporal hemianopsia associated with normal visual acuity. Traumatic chismal syndrome should be considered in the differential diagnosis of patients presenting with bitemporal hemianopsia. Keywords: Bitemporal hemianopsia; head trauma; optic chiasmal injury; traumatic chiasmal syndrome. INTRODUCTION Bitemporal hemianopsia is a sign that typically indicates an mission to an emergency clinic, he was conscious and com- optic chiasmal involvement, mostly caused by a compressive plained of blurred vision, and bilateral periorbital ecchymosis tumor.[1] Traumatic chiasmal injury, also called traumatic chi- was noted. Computed tomography showed frontal, ethmoid, asmal syndrome (TCS), is a rare phenomenon and can mani- and maxillary fractures in the right orbit, fractures in the sel- fest with a variety of visual defects.[2] Herein, it was aimed to lar region of the sphenoid bone, and air in the orbit and cra- report a case of TCS with an isolated, complete bitemporal nium (Fig.
    [Show full text]
  • Chiasmal Syndrome Chiasmal Syndrome
    10/3/2016 Chiasmal Syndrome • Online notes – richardtrevino.net • Email me Everything You Always Wanted – [email protected] to Know About PITUITARY ADENOMA • Disclosures But Were Afraid to Ask! – None Rick Trevino, OD, FAAO Rosenberg School of Optometry Chiasmal Syndrome Chiasmal Syndrome • Chiasmal syndrome is the constellation of • Causes of chiasmal syndrome include tumor, signs and symptoms associated with lesions inflammation, and ischemia of the optic chiasm • Findings suggestive of an etiology other than – Pituitary adenoma is the most common cause pituitary adenoma: – Visual sxs (blur or difficulties with side vision) • 25% of all brain tumors occur in this region – Younger age – 50% are pituitary ademomas – Unilateral optic disk pallor – Visual disturbance is common – RAPD • Patients with chiasmal lesions may present – A complete hemianopic VF defect c/o headache and/or visual disturbances – VF defect greater inferiorly than superiorly AJO 2004;137:908-913 Incomplete bitemporal Chiasmal Syndrome hemianopic defect greater above than below – highly • Anatomy Review suggestive of pituitary anenoma • All About Pituitary Pituitary Adenomas • Incomplete Clinical Features of bitemporal Chiasmal Syndrome hemianopia greater below • Clinical Pearls than above – highly suggestive of – Red Flag Warning Signs something other – Chiasmal Work-up than pituitary Something Else adenoma 1 10/3/2016 The pituitary gland is located 10mm immediately below the optic chiasm T1-weighted T2-weighted coronal MRI sagital MRI Pituitary Adenoma Pituitary
    [Show full text]
  • Chiasm. Wilbrand's Knee Is a Loop of Decussating Fibers
    WILBRAND'S KNEE OF THE PRIMATE OPTIC CHIASM IS AN ARTEFACT OF MONOCULAR ENUCLEATION* BY Jonathan C. Horton, MD, PhD ABSTRACT Purpose: The anterior chiasmal syndrome consists of a temporal hemi- anopia or complete visual field loss in one eye, plus a superior temporal hemianopia in the other eye. The superior temporal hemianopia in the other eye is thought to result from injury to Wilbrand's Knee of the optic chiasm. Wilbrand's Knee is a loop ofdecussating fibers which detours into the contralateral optic nerve before entering the optic tract. I studied the organization of fibers in the optic chiasm of monkeys and humans to veri- fy the existence ofWilbrand's Knee and to elucidate further the pattern of visual field loss seen from lesions of the sellar region. Methods: The primary optic pathway was labelled in monkeys by injection of [3H] proline into one eye, followed by autoradiography. There were 8 intact Rhesus monkeys and 3 intact squirrel monkeys. In addition, the optic pathway was studied in the Rhesus monkey 6 months and 4 years after monocular enucleation. The optic chiasm was also examined using myelin stains in specimens obtained post-mortem from 3 patients. The patients had lost 1 eye 5 months, 2 years, and 28 years prior to their deaths. Finally, clinical observations were recorded in 3 patients with the anterior chiasmal syndrome. Results: In normal Rhesus and squirrel monkeys, optic nerve fibers crossed the optic chiasm without entering the contralateral optic nerve. After short-term monocular enucleation, fibers from the normal optic nerve were drawn closer to the entry zone ofthe degenerating optic nerve, but Wilbrand's Knee was still absent.
    [Show full text]