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.
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.
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