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A homonymous quadrantanopic visual field defect was discovered in a healthy, asymptomatic 43-year-old female. Computerized tomography revealed the source of the field defect. Since visual field defects can be associated with life threatening disorders, eye examinations should include some assessment of the visual field.
Nerve fibre bundle visual field defects are the hallmark of pathology at the optic nerve head or retina. In the present series, six eyes of four patients with large intracranial mass lesions demonstrated such field defects with visual acuity spared in three of the involved eyes. In no cases did visual function in the opposite eye offer a clue to the localization of the lesion.
Neoplastic angioendotheliomatosis (NAE) is a rare, fatal disease characterized by widespread intravascular proliferations of malignant cells of putative endothelial origin. Clinically, dermatologic and bizarre neurological manifestations predominate, but review of the reported cases of NAE reveals ophthalmic involvement to be frequent. To our knowledge, no reports of NAE have appeared in the ophthalmic literature. We describe three cases of NAE with the ocular manifestations of visual loss, cells in the vitreous, retinal artery occlusion, retinal vascular and pigment epithelial alterations, nystagmus, and cortical blindness. Autopsies (including eyes and central nervous system) revealed pancorporal involvement by intravascular anaplastic cells in each patient. In two patients massive extravascular involvement was also present. The tumor cells lacked ultrastructural features of endothelial cells and failed to stain for factor-VIII-related antigen. Common leukocyte antigen, a maker for hematopoietic cells, particularly lymphocytes, was detected on tumor cells in all cases, indicating that NAE is probably an extranodal lymphoma. The dramatic response of the central nervous system lesions to radiotherapy in one case supports this contention. It is suggested that this disorder be treated as a malignant lymphoma.
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The authors describe two cases of sphenoïd sinus mucoceles, the first with a chiasmatic syndrome and the second with an oculomotor paralysis, and compare these cases with those described in the litterature. This rare benign tumor is revealed by ophthalmological complications which result from compression of adjacent structures. The main clinical findings are pain, decrease in visual acuity, proptosis, and diplopia. Plain X rays and pluridirectional tomographies are usually sufficient to make the diagnosis but CT scan is the procedure of choice for defining the extent of the lesion and thus assuring an appropriate surgical approach. The CT scan findings have been reviewed. Early and correct diagnosis is important to prevent permanent visual loss by optic nerve atrophy.
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In two case of cystic craniopharyngioma the initial presentation was misleading and suggested acute retrobulbar optic neuritis: 1) isolated and unilateral drop of visual acuity of recent onset; 2) total remission in a few weeks, then a relapsing and steroid-sensitive course; 3) increase of C.S.F. gammaglobulins content in one case, normal CT scan in the second one. The diagnosis was corrected 36 and 18 months respectively after the onset of the clinical disorders.
272 cases with visual field defects were examined by CT and analysed. 78 patients showed a chiasmatic lesion, 45 patients a lesion of the optic tract or the lateral geniculate body and 136 patients a lesion of the optic radiation or the occipital cortex. 96% of the CT pictures were topographically corresponding to the known optic field defect. In more then 75% of the operated patients the nature of the CT lesion was confirmed. 10 cases were negative in CT and 3 false positive. Because of the high rate of exact topographic diagnosis CT should be the initial investigation in visual field defects. But the nature of a lesion has to be diagnosed with caution, taking into account the entire clinical picture.
The results of 67 examinations with computerized axial tomography are presented with reference to the indications. 15 examinations were performed in exophthalmos, 11 in unknown visual field defects, 9 in optic atrophy of unknown origin, 8 each in optic neuritis, papilledema and unclear visual disturbance. 8 furthur examinations were performed in different cases. The axial computerized tomography proved to be an efficient complementary examination technique if it is limited to well defined indications. The best results are obtained examining exophthalmos and visual field defects.
In 6 cases of oxycephaly, isotope (RIHSA) cisternography showed an altered CSF circulation with ventricular reflux or cisternal block and accumulation of the contrast at lumbosacral level. These changes express increased absorption of the CSF by the spinal arachnoid villi to compensate for reduced or nonexistent absorption by the subarachnoid villi of the vault, obstructed by chronic intracranial hypertension secondary to craniosynostosis. The possible clinical implications are outlined.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.