Traumatic chiasmal syndrome: A meta-analysis

Mookan, Loganathan Vellayan; Thomas, Philip A.; Harwani, Ankit Anil

doi:10.1016/j.ajoc.2018.01.029

Cited by 6 publications

(7 citation statements)

References 16 publications

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“…Our patient showed improvement in visual acuity despite persistent bitemporal hemianopia similar to the previously reported case [9]. Previous studies found that patients with traumatic bitemporal hemianopia had frontal and anterior basal skull fractures associated with intracerebral and subarachnoid hemorrhage similar to our present case [2,5].…”

Section: Discussionsupporting

confidence: 90%

Isolated Traumatic Bitemporal Hemianopia

Fauzi¹,

Sharina²,

Ibrahim³

2021

Cureus

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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.

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Section: Discussionsupporting

confidence: 90%

Isolated Traumatic Bitemporal Hemianopia

Fauzi¹,

Sharina²,

Ibrahim³

2021

Cureus

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“… 2 , 3 , 5 High-velocity closed head injuries – particularly motor vehicle accidents – are the most common mechanism of injury, and traumatic chiasmopathy is often accompanied by other cranial neuropathies, cerebrospinal fluid leaks from calavarial fractures, and endocrine dysfunction from pituitary injury. 2 , 3 , 4 , 5 , 6 , 7 , 8 As in this case, neuroimaging frequently does not reveal lesions of the optic chiasm at the time of injury. 2 , 5 Multiple pathogenic mechanisms for traumatic chiasmopathy have been proposed, including direct mechanical injury to crossing axons, ischemia from shearing of vessels perfusing the chiasm, and compression from perichiasmal hematomas or cerebral edema.…”

Section: Discussionmentioning

confidence: 64%

“…Traumatic chiasmal injury is rare and, as with other chiasmal syndromes, classically results in bitemporal hemianopsia. 1 , 2 , 3 , 4 , 5 Asymmetric vision loss between the two eyes is common, and several cases of profound unilateral vision loss with temporal visual field defects in the fellow eye have been reported. 2 , 3 , 5 High-velocity closed head injuries – particularly motor vehicle accidents – are the most common mechanism of injury, and traumatic chiasmopathy is often accompanied by other cranial neuropathies, cerebrospinal fluid leaks from calavarial fractures, and endocrine dysfunction from pituitary injury.…”

Section: Discussionmentioning

confidence: 99%

“… 1 It most commonly results from closed head injuries secondary to high-velocity mechanisms such as motor vehicle accidents and falls from substantial heights. 1 , 2 , 3 , 4 Similar to other chiasmal lesions, traumatic chiasmopathy results in bitemporal hemianopsia and may or may not be associated with radiographic abnormalities such as optic chiasm enhancement on gadolinium-enhanced magnetic resonance imaging (MRI). 4 Here, we report a case of traumatic optic neuropathy and chiasmopathy in a patient with thyroid orbitopathy who sustained mild head trauma as a result of a fall from standing height.…”

Section: Introductionmentioning

confidence: 99%

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Traumatic chiasmopathy following mild trauma in a patient with thyroid orbitopathy

O’Sullivan

Gospe

2021

American Journal of Ophthalmology Case Reports

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Purpose Traumatic injury to the optic chiasm is rare and most frequently caused by high-velocity head trauma. It classically results in bitemporal hemianopsia and often presents in conjunction with multiple other traumatic injuries, such as skull fractures and cerebrospinal fluid leaks. We present the case of a 40-year-old woman with pre-existing thyroid orbitopathy who struck her forehead after a fall from standing height. Observations This patient suffered immediate profound unilateral vision loss from traumatic optic neuropathy and possible optic nerve avulsion. The fellow eye manifested a temporal hemianopsia with delayed retinal nerve fiber layer and nasal hemimacular ganglion cell layer thinning on optical coherence tomography, consistent with chiasmal pathology. Magnetic resonance imaging showed no definitive lesions at the optic chiasm or more posteriorly along the afferent visual pathway. Conclusions and importance This patient's severe vision loss suggests that proptosis from thyroid orbitopathy can sensitize the anterior visual pathway to trauma. In this case, we propose that the lack of laxity in the intra-orbital optic nerves allowed transmission of stretching forces to the optic chiasm in the setting of low-velocity blunt trauma.

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“…Patients with supposed CS should undergo a comprehensive eye examination including visual acuity, pupil responses, ocular motility, IOP measurement, anterior biomicroscopy, direct ophthalmoscopy, color vision testing and careful visual field testing [4,10]. The main ophthalmologist's task in these patients is to detect early signs of compressive optic neuropathy before descending optic nerve atrophy develops.…”

Section: Intrachiasmal Lesionsmentioning

confidence: 99%

Neuro-opthalmological aspect of chiasmal-and-sellar disorders

Vasyuta¹,

Pedachenko²

2018

Oftalmol Zh

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This article reviews the causes, pathogenesis, and major manifestations of chiasmal syndrome. In addition, it reviews the methods for diagnosing the condition, and the course of the syndrome in patients with various chiasmal-and-sellar disorders such as pituitary adenoma, craniopharyngioma, tuberculum sellae meningioma, and skull base aneurysm. The principle neuro-ophthalmological symptoms include decreased visual acuity, bitemporal visual field defects, and development of descending optic nerve atrophy. Early detection of ophthalmological symptoms is of critical importance for timely neurosurgical treatment.

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Traumatic chiasmal syndrome: A meta-analysis

Cited by 6 publications

References 16 publications

Isolated Traumatic Bitemporal Hemianopia

Isolated Traumatic Bitemporal Hemianopia

Traumatic chiasmopathy following mild trauma in a patient with thyroid orbitopathy

Neuro-opthalmological aspect of chiasmal-and-sellar disorders

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