A series of 15 patients with a clinical diagnosis of pituitary apoplexy is reviewed. Clinical features are highlighted, with stress on the defects of visual function and ocular motility, and the associated endocrine abnormalities are described. Potential diagnostic errors and their significance are considered. The incidence of this complication in a large series of pituitary adenoma patients is measured, and the radiological and pathological findings are recorded. The results of treatment by surgery and/or radiotherapy and/or bromocriptine are assessed, particularly in relation to visual consequences, and compared with previous reports in the literature, which are reviewed.

The representation of the field of vision in the human striate cortex is based on the Holmes map in which about 25% of the surface area of the striate cortex is allocated to the centrallS degrees of vision. Foliowing the introduction of computed tomography of the brain, he accuracy of the Holmes map was apparently confirmed by clinical/radiological correlation, but a revision has been proposed by Horton and Hoyt based on a magnetic resonance imaging study ofthree patients with visual field defects due to striate lesions. They propose that the central cortical representation of vision occupies a much larger area. This study reviews the perimetric and imaging findings in a larger series of patients with striate cortical disease and provides support for the revised representation. The clinical phenomenon of macular sparing and its relation to representation of the macula at the occipital pole is also discussed. (BrJ Ophthalmol 1994; 78: 185-190)

A series of 15 patients with a clinical diagnosis of pituitary apoplexy is reviewed. Clinical features are highlighted, with stress on the defects of visual function and ocular motility, and the associated endocrine abnormalities are described. Potential diagnostic errors and their significance are considered. The incidence of this complication in a large series of pituitary adenoma patients is measured, and the radiological and pathological findings are recorded. The results of treatment by surgery and/or radiotherapy and/or bromocriptine are assessed, particularly in relation to visual consequences, and compared with previous reports in the literature, which are reviewed.

To demonstrate spontaneous regression of large, clinically symptomatic optic pathway gliomas in patients with and without neurofibromatosis type 1 (NF-1). Methods: Patient cases were collected through surveys at 2 consecutive annual meetings of the North American Neuro-Ophthalmology Society (NANOS) and through requests on the NANOSNET Internet listserv. Serial documentation of tumor signal and size, using magnetic resonance imaging in 11 patients and computed tomography in 2 patients, was used to evaluate clinically symptomatic optic pathway gliomas. All tumors met radiologic criteria for the diagnosis of glioma and 4 patients had biopsy confirmation of their tumors. In 3 patients, some attempt at therapy had been made many years before regression occurred. In one of these, radiation treatment had been given 19 years before tumor regression, while in another, chemotherapy had been administered 5 years before signal changes in the tumor. In the third patient, minimal surgical debulking was performed 1 year before the tumor began to shrink. REPORT OF CASES CASE 1 A healthy 5-year-old boy was believed to have severe amblyopia with hand motion vision in the right eye during a school examination. At age 7 years, right optic disc atrophy was recognized. His left eye was normal. He had 7 café-au-lait spots, but no Lisch nodules on his irides. There was no history of NF-1 or ocular problems in his family. Magnetic resonance CLINICAL SCIENCES Author affiliations are located at the end of this article.

The lack of a standard quantitative method of assessing the degree of visual deficit hinders comparison of the results of the different methods available for treating visual failure due to a pituitary tumour. This report describes a simple, semi-quantitative, and precise approach, and illustrates its use in 34 patients treated by transsphenoidal hypophysectomy and radiotherapy. Visual improvement occurred in 85%, and no patient sustained deterioration of vision. Visual loss before operation was scored at a mean of 51.4%, and was reduced to a mean of 27.4% after a minimum of 12 months follow-up. The factor that had the greatest influence on visual recovery was the degree of visual loss at presentation. It is therefore essential to be able to compare this variable before attempting to assess if outcome is different in patients treated by different methods.

Twelve patients with fibrous dysplasia of the orbit are reviewed and the ophthalmic findings described. Three case histories are presented in detail. Six patients were managed conserva-

Optochiasmal arachnoiditis has been reported following treatment of ruptured intracranial aneurysms, particularly arising from the anterior communicating artery. It has been suggested that the accompanying loss of vision is due to a muslin-induced optic neuropathy. This paper considers five cases of this condition; the response to steroid therapy was beneficial in three cases. A review of the literature is included. The arachnoiditis is considered to be due to an inflammatory response to muslin gauze placed close to the optic nerves and chiasm.

The neuro-ophthalmic features of 11 traumatic carotid cavernous fistulas and their successful occlusion by endoarterial balloon embolisation is reported. Significant improvement in all neuro-ophthalmic signs and symptoms occurred following treatment, however, ocular motility deficits persisted in 7 patients. All 11 fistulas were occluded and the patency of the internal carotid artery was preserved in 9 patients. Though the internal carotid artery was sacrificed in 2 patients there were no permanent sequelae. Transient complications of the procedure occurred in 2 patients.