Isolated Traumatic Bitemporal Hemianopia

Abstract

Bitemporal hemianopia is a rare presentation following severe head injury, which causes a delay in detection of the visual symptoms. This is a case of traumatic bitemporal hemianopia in a 20-year-old gentleman after an alleged motorbike accident. He was intubated following a severe head injury. The ophthalmologic assessment was performed after he regained consciousness and complained of acute blurring of vision in bilateral eyes. The visual acuity was 2/60 on the right eye and 4/60 on the left eye. Bilateral eyes anterior and posterior segments examination were unremarkable. Confrontation visual field testing discovered bitemporal hemianopia. Plain computed tomography (CT) scan of the brain showed right frontal bone fracture extending to the right orbital roof, superomedial wall of the right orbit, bilateral lamina papyracea, ethmoidal air cells, roof and bilateral walls of sphenoid sinus. He was treated conservatively by the ophthalmology team. Subsequent follow-ups showed improvement of visual acuity which were 6/6 on the right eye and 6/6 on the left eye. Humphrey visual field test confirmed the persistence of bitemporal hemianopia. His good visual acuity does not correlate with the severity of the field defect. Therefore, surveillance for bitemporal scotoma is necessary for all head injuries with severe midline facial bone fractures.

Motorcycle-Associated Ocular Injuries: A Narrative Review

“… Yes Orbital Fractures Norazah et al 35 2011 Malaysia N/A Case Report N/A To present a case of globe avulsion after a motorcycle accident. Yes Other - globe avulsion Ahmad Fauzi et al 36 2021 Malaysia N/A Case Report N/A To present a case of bitemporal hemianopia after a motorcycle accident. Yes Neuro Ophthalmic Zhang-Nunes et al 37 2012 United States N/A Case Report N/A To present a case of globe prolapse into maxillary sinus after motorcycle-associated trauma.…”

“… It was found that no individuals with optic nerve injury recovered to their baseline visual acuity, and those with ocular motor manifestations had variable recovery. Case Reports Kal et al 19 Male 22 Abducens nerve palsy and Horner Syndrome Cannot be Determined Sinawat et al 29 Male 47 Cortical blindness Bilateral loss of visual acuity Ahmad Fauzi et al 36 Male 20 Bitemporal hemianopia secondary to traumatic chiasmal syndrome Unilateral loss of visual acuity Sherman et al 42 Male 31 Traumatic optic neuropathy Bilateral loss of visual acuity Gotfried et al 60 Female 45 Ptosis caused by complete third nerve palsy Cannot be Determined Vien et al 65 Male 25 Transsynaptic retrograde degeneration and homonymous hemianopsia Full recovery of VA Alderazi et al 72 Male 45 Right carotid-cavernous fistula Cannot be Determined Meena et al 76 Male 41 Optic nerve transection Unilateral blindness Kastelan et al 79 Male 47 Traumatic optic neuropathy Full recovery of VA …”

“…A total of 12 studies were identified that described neuro-ophthalmic manifestations secondary to motorcycle accidents. 19 , 29 , 36 , 42 , 47 , 60 , 65 , 72 , 76 , 79–81 Only one of these 12 studies was not a case report and described the neuro-ophthalmic complications associated with motorcycle and moped accidents observed in two centers over an 18-year period. 47 This study described 94 motorcycle-associated neuro-ophthalmic injuries and 2 moped-associated neuro-ophthalmic injuries.…”

“…Four of the remaining 11 case reports describing neuro-ophthalmic injuries also described the same types of injuries observed by Keane et al 19 , 60 , 72 , 81 The other seven case reports described other neuro-ophthalmic manifestations secondary to motorcycle accidents, including bitemporal hemianopia secondary to traumatic chiasmal syndrome, permanent cortical blindness, traumatic optic neuropathy, optic nerve transection, and retrograde degeneration of retinal ganglion cells. 29 , 36 , 42 , 65 , 76 , 79 , 80 All but one of these case reports involved males, and all cases of neuro-ophthalmic injury were observed in adults ( Table 5 ).…”