Traumatic Chiasmal Syndrome Associated With Midline Basilar Skull Fractures

Heinz, Grant W.; Nunery, William R.; Grossman, Charles

doi:10.1016/s0002-9394(14)73020-x

Cited by 36 publications

(19 citation statements)

References 14 publications

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“…[30][31][32] In cases 1 and 3 the appearance of the optic nerves and formal visual field testing were normal (figs 1C and D, 3E and F) The finding of normal visual fields in association with an isolated small chiasm on neuroimaging has been reported previously. 15 23 27 A full visual field is consistent with studies of the lateral geniculate body (LGN) in the canine model of isolated achiasmia: misdirected nasal fibres form ipsilateral mirror image maps in those LGN layers that normally would have received nasal fibres from the contralateral eye.…”

Section: Visual Fields In Achiasmiasupporting

confidence: 59%

The achiasmia spectrum: congenitally reduced chiasmal decussation

Sami

2005

British Journal of Ophthalmology

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Aim: To describe the clinical spectrum of achiasmia, a congenital disorder of reduced relative decussation at the optic chiasm. Methods: A retrospective case note and patient review of nine children (four boys). Achiasmia was defined by the combination of a characteristic asymmetry of the monocular visual evoked potential (VEP) response to flash and neuroimaging showing reduced chiasmal size. Results: Three of the children had an associated skull base encephalocele with agenesis of the corpus callosum. In two patients achiasmia was associated with septo-optic dysplasia. Three patients had no neuroimaging abnormalities other than reduced chiasmal size and have no known pituitary dysfunction. One child had multiple physical deformities but the only brain imaging abnormality was reduced chiasmal size. Conclusions: Some children with disorders of midline central nervous system development, including septo-optic dysplasia and skull base encephaloceles, have congenitally reduced chiasmal decussation. Reduced relative decussation may co-exist with overall chiasmal hypoplasia. Children with an apparently isolated chiasmal decussation deficit may have other subtle neurological findings, but our clinical impression is that most of these children function well.

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Section: Visual Fields In Achiasmiasupporting

confidence: 59%

The achiasmia spectrum: congenitally reduced chiasmal decussation

Sami

2005

British Journal of Ophthalmology

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“…20–23 Compressive lesions of the chiasm commonly show partial bitemporal hemianopia, 22 as seen in our patient 1. While some post-operative improvement in visual fields is noted in up to 87% of the patients undergoing pituitary surgery, complete recovery to normal visual fields is only found in about 18%.…”

Section: Discussionsupporting

confidence: 66%

Bitemporal hemianopia; its unique binocular complexities and a novel remedy

Peli

Satgunam

2014

Ophthalmic Physiologic Optic

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Bitemporal hemianopic visual field impairment frequently leads to binocular vision difficulties. Patients with bitemporal hemianopia with pre-existing exophoria complain of horizontal diplopia, sometimes combined with vertical deviation (with pre-existing hyperphoria). The symptoms are a result of the phoria decompensating into a tropia (hemi-slide) due to the lack of retinal correspondence between the remaining nasal fields of both eyes. We measured these effects using a dichoptic perimeter. We showed that aligning the eyes with prisms could prevent diplopia if the bitemporal hemianopia is incomplete. We also describe the successful use of a novel fusion aid – the ‘stereo-typoscope’ – that utilizes midline stereopsis to prevent diplopia resulting from hemi-sliding in patients with complete bitemporal hemianopia.

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“…Affected patients are noted to have midline basilar skull fractures that traverse the midclivus through the sella turcica floor, dorsum sella, and sphenoid sinus. 2 The visual field defect usually starts immediately after the insult but is diagnosed late in view of altered sensorium in these patients with severe head injury, although the resultant degree of visual loss may not necessarily reflect the severity of the head injury.…”

Section: Discussionmentioning

confidence: 99%

“…2 We believe that it belongs to the same spectrum as diffuse axonal injury, but more specific where the injury is a result of shearing forces concentrated only on the midline or junctional structures. These forces may cause selective tearing and stretching of the chiasmal crossing fibres and pituitary stalk.…”

Section: Mechanismmentioning

confidence: 99%

Traumatic Chiasmal Syndrome: A Midline Axonal Injury

Vora

Ravi

2015

Neuro-Ophthalmology

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We report a 26-year-old man who developed cerebrospinal fluid (CSF) rhinorrhoea and complete bitemporal hemianopia after having sustained a blunt frontal region trauma. The chronology of midline frontal trauma and CSF rhinorrhoea, followed days later by transient diabetes insipidus and discovery of a bitemporal visual field loss, makes up a unique syndrome and must be evaluated for. Mechanism of such injuries, their pertinent complications, and review of literature are herein discussed.

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Traumatic Chiasmal Syndrome Associated With Midline Basilar Skull Fractures

Cited by 36 publications

References 14 publications

The achiasmia spectrum: congenitally reduced chiasmal decussation

The achiasmia spectrum: congenitally reduced chiasmal decussation

Bitemporal hemianopia; its unique binocular complexities and a novel remedy

Traumatic Chiasmal Syndrome: A Midline Axonal Injury

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