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A Clinical Approach to Abnormal Eye Movements
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
See-saw nystagmus (SSN) is an unusual pattern in which one eye moves downward and extorts, while the other eye rises and intorts. The torsional component is conjugate, while the vertical is disconjugate. SSN can be of a pendular type or the jerk type, hemi-see-saw nystagmus (HSSN). The pendular type is usually due to a suprasellar lesion in most cases. Bitemporal hemianopsia, poor visual acuity and exodeviations are common accompaniments.
Evaluation and Investigation of Pituitary Disease
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Tumours with suprasellar extension may lead to peripheral visual field defects. The classical bitemporal hemianopia is not always seen; however, some degree of visual field defect is frequently observed even in patients who do not complain of visual symptoms. Perimetry is the preferred method of visual field testing. Testing should be conducted in all patients with sellar lesions that are in contact with the optic chiasm.
Answers
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
Bitemporal hemianopia usually results from damage at the optic chiasm where the nasal (medial) retinal nerve fibres cross to the contralateral side. The nasal retinal field visualises the temporal (lateral) visual field. This condition can arise from compression from an enlarged pituitary gland. These can be functioning or non-functioning tumours. Functioning tumours will give rise to endocrine abnormalities, for example, acromegaly, hyperprolactinaemia, Cushing’s disease, thyrotoxicosis.
Preoperative embolization of suprasellar hemangioblastoma supplied by artery of foramen rotundum: a case report and review of the literature
Published in British Journal of Neurosurgery, 2023
Sungjun Moon, Hui Joong Lee, Subum Lee
A 69-year-old woman presented with visual disturbance for 10 months. Ophthalmological examination showed bitemporal hemianopsia. Brain MRI showed a 3.2 × 2.0 × 2.9 cm3 mass in the suprasellar region that extended into sellar region and planum sphenoidale, but did not invade the cavernous sinus or other adjacent structures. The mass was isointense on T1-weighted images, hyperintense on T2-weighted images, and avidly enhanced after gadolinium injection. A linear flow void inside the mass was identified (Figure 1). The differential diagnosis included hemangioblastoma and pituitary adenoma. Hormonal examination and evaluation for VHL found no abnormalities. No genetic study was performed in the present case because of patient refusal, but there was no evidence of VHL on whole-body CT scans and no relevant family history. Transfermoal carotid angiography showed that the right half of the mass was fed by small perforators from the right distal internal carotid artery (ICA) and that the left half was fed by a transdural artery from the distal internal maxillary artery (IMA). The transdural artery was considered to be the AFR, because of its course and distinctive corkscrew shape (Figure 2). Preoperative AFR embolization was performed under general anesthesia.
Transient Visual Obscurations Without Papilloedema as the Heralding Symptom of Chiasmal Compression
Published in Neuro-Ophthalmology, 2023
Niels A. Ryden, Helena Lam, Casey Judge, Andrew S. Venteicher, Michael S. Lee
Sefi-Yurdakul reported a case of TVOs in a 51-year-old woman with a pituitary macroadenoma.8 This patient also demonstrated a bitemporal hemianopia and reduced visual acuity. No information was provided on whether postoperative resolution of the TVOs occurred. Moreover, there was no description of the symptoms beyond ‘transient visual obscuration’ for this individual, and this may not comport with our understanding of TVOs. For example, Hilton-Jones et al. reported two patients with ‘transient visual obscurations’ secondary to frontal lobe tumours, which they described as painful vision loss lasting 5–30 min.9 An additional case of transient vision loss with 30-min episodes was described in a 23-year-old woman with physiological pituitary gland enlargement during pregnancy.10 Her peri-partum MRI showed cephalad expansion of the pituitary gland with contact to the left side of the optic chiasm. Resolution of her transient vision loss occurred shortly post-partum, and her follow-up MRI showed a reduction in the size of the pituitary gland. These episodes were poorly defined and lasted much longer than typical TVOs. They may represent another cause, such as migraine aura.
Pituitary metastasis from renal cell carcinoma: case report and review of the literature
Published in International Journal of Neuroscience, 2021
Bin Li, Jian-Hua Cheng, Hai-Bo Zhu, Chu-Zhong Li, Ya-Zhuo Zhang, Peng Zhao
Ophthalmological examination revealed bitemporal hemianopsia and reduced visual acuity (naked vision is 0.8 and 0.4 in the right and left eyes, respectively). In the follow-up, the patient underwent staging examinations. Endocrine examination results are showed in Table 1. Brain computed tomography (CT) showed a tumor of the sellar region with suprasellar extension compressing the optic chiasm and eroding the sellar floor (Figure 1), which was considered pituitary adenoma. Brain magnetic resonance imaging (MRI) showed that the sellar was enlarged (Figure 2), the sellar bottom was sunken, the pituitary stalk was not clear, and the chiasm was uplifted. The tumor is imaged as same intensity as cerebral cortex in T1-weighted MRI images and a slightly longer T2 signal, measuring 23 × 28 × 34 mm in diameter. Brain magnetic resonance enhanced scans showed significant enhancement of under-homogeneity (Figure 3). It may be indicated pituitary adenoma.