Atypical junctional scotoma secondary to optic chiasm atrophy: a case report

Pearls & Oy-sters: Case Report of a Ruptured Suprasellar Dermoid Cyst Presenting With Junctional Scotoma of Traquair

“…At the optic chiasm, about 53% of the 2.4 million axons cross, while 47% remain ipsilateral. 1 Lesions at the chiasm, depending on size and location, can cause a variety of visual field defects and vision loss. A classic bitemporal hemianopia results from compression of the decussating fibers bilaterally at the decussation.…”

“…4 The most common causes of junctional scotoma of Traquair include pituitary adenoma, sphenoid wing meningioma, craniopharyngioma, and aneurysms of the internal carotid or the anterior communicating artery. 1 The incidence of junctional scotoma of Traquair varies according to different studies but is likely seen in around 1%-2% of patients with pituitary adenomas. 2,5,6 Our patient's visual field changes progressed with increasing involvement of the chiasm to a classic bitemporal hemianopia pattern before surgical decompression.…”

Metastatic paraganglioma presenting as ajunctional scotoma

“…Junctional scotomas are defined as a unilateral central scotoma and a contralateral temporal visual field defect, commonly in the superior-temporal quadrant. 3 Junctional scotomas have been previously thought to be related to the damage of Wilbrand's knee, a loop of decussating fibers that detours into the contralateral optic nerve before entering the optic tract, but this has been challenged by other studies that postulate that Wilbrand's knee is an artifact of monocular enucleation, and Wilbrand fibers form only after an adequate length of time after enucleation. 4 , 5 Junctional scotomas can be caused by intracranial masses, inflammatory lesions, or vascular lesions with pituitary tumors the most common cause.…”