MRCPsych Paper A1 Mock Examination 4: Answers
Melvyn WB Zhang, Cyrus SH Ho, Roger Ho, Ian H Treasaden, Basant K Puri in Get Through, 2016
Scotoma is defined as an area of reduced vision (e.g. central scotoma) and is commonly caused by demyelinating diseases such as multiple sclerosis or macular degeneration. Hemianopia is defined as loss of half of visual field of both eyes (either left side or right side). Damage to the right posterior portion of the brain usually causes a loss of the left half of visual fields in both eyes. Similarly, damage to the left posterior brain usually causes a loss of right half of visual fields in both eyes. Homonymous quadrantanopia is defined as loss of either outer upper or lower quadrant of visual field of one eye. For example, left superior homonymous quadrantanopia is caused by right temporal lobe lesion. Bitemporal hemianopia is defined as loss of outer half of visual fields in both eyes and is commonly caused by pituitary tumour.
Helping women to ovulate
David J Cahill in Practical Patient Management in Reproductive Medicine, 2019
Nonsecreting pituitary tumours can also give rise to problems and symptoms, largely due to their bulk and increase in size. These symptoms include headaches, nausea or vomiting, with occlusion of vision, giving rise to tunnel vision or bitemporal hemianopia. These tumours affect hormone production by the pituitary if normal pituitary tissue is squeezed within the restricted enclosure of the bony pituitary fossa. Bitemporal hemianopia is a serious condition which, if not treated, can lead to permanent optic nerve damage and blindness. I treated a male accountant who presented in this way – his first symptom was that he could not see the figures in spreadsheets at the outside of the pages he was working on!
Examine the cranial nerves
Hani TS Benamer in Neurology for MRCP PACES, 2019
Q: What are the causes of the visual field defect? (a) Bitemporal hemianopia is usually caused by pituitary tumour. Other causes include craniopharyngioma, meningioma and large internal carotid artery aneurysm.(b) Homonymous hemianopia is usually caused by cerebrovascular disease such as occipital infarction or haemorrhage. Other causes include tumours.
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.
Nomogram Using Optical Coherence Tomography and Visual Field Parameters to Predict Brain Lesions in Patients with Bitemporal Hemianopia
Published in Current Eye Research, 2019
Sangah Kim, Hyoung Won Bae, Chan Keum Park, Kwanghyun Lee, Sang Yeop Lee, Gong Je Seong, Chan Yun Kim
Data from patients with complete or incomplete bitemporal hemianopia were enrolled in this study. Complete bitemporal hemianopia was defined as a VF defect in the outer half of both right and left visual field, and involved the entire hemifield on the affected side. Incomplete bitemporal hemianopia was defined as a VF defect that respected the vertical meridian but spared some of the VF on the involved side. Abnormal VF defect meant that a cluster of at least three locations depressed at the points with a probability <5%, one of which had to be depressed at the points with a probability of <1% on a pattern deviation plot, or a cluster of two locations with a probability of <1% with respect to the vertical meridian on two consecutive tests (24–2 or 30–2 SITA Standard Algorithm, Humphrey Field Analyzer, Carl Zeiss Meditec, Dublin, CA, USA). Reliability was defined as fixation loss ≤ 20%, false-positive ≤ 33%, and false-negative ≤ 33%.1,20 All visual field tests were interpreted by two independent glaucoma specialists (SAK and HWB). In cases of discrepancy, visual fields were reviewed by CYK.
Oligosypthomatic ovarian hyperstimulation syndrome in a spontaneous uneventful pregnancy. A case report
Published in Gynecological Endocrinology, 2019
Elena Morotti, Cesare Battaglia
In the non-pregnant group, 5 women were assigned to Type 1, 1 to Type 2 (extragonadal choriocarcinoma of the mediastinum), 10 to Type 3 and 40 to Type 4 of de Leener classification [10]. Furthermore, in 4 cases it was reported recurrent spOHSS with no definitive diagnoses. Among the above patients, 3 were children and 56 adult women. The most common disturbances included amenorrhea, oligomenorrhea/irregular menses, and difficulties in conceiving [1]. Other complaints were abdominal or pelvic pain, abdominal distension, and increased girth. Less common findings were nausea and vomiting. Although the presence of grossly enlarged ovaries with multiple cysts, in almost all of the reported cases ascites was not detected [1]. Neurological symptoms (bitemporal hemianopsia, scotoma, loss of visual acuity, headache) generally occurred with pituitary tumor ≥20 mm in maximum diameter. In cases of prolactinomas, galactorrhea was often present [1]. Of the total 59 cases, 3 presented with acute abdomen caused by ovarian torsion and were submitted to laparoscopic unwinding or adnexectomy[16,19]. Etiological treatment with levothyroxine, bromocriptine/cabergoline or, where indicated, transphenoidal surgery favored the ovarian cysts regression and restored normal cycles and fertility.
Related Knowledge Centers
- Aneurysm
- Anterior Communicating Artery
- Craniopharyngioma
- Meningioma
- Optic Nerve
- Optic Tract
- Visual Impairment
- Pituitary Gland
- Pituitary Adenoma
- Optic Chiasm