When I was in UK, I attended a PACES course. There were 3 patients whom I was asked to examine the visual fields and the findings were bitemporal hemianopia. They also had a scar as shown above. In fact, they had craniopharyngioma which has been operated via a transfrontal approach. You don't always get a clear scar like this in the exam. So, sometimes you have to look in between the hairs for the scar.
Where is the lesion ? Optic chiasm
If you are asked to examine the eyes,
1) Inspection for scars (transfrontal and transphenoidal)
2) Examine the visual acuity with a Snellen chart
3) Test the visual fields (you will find bitemporal hemianopia)
4) Check light reflex and look for RAPD(relative afferent pupillary light reflex or Marcus Gunn pupil), accomadation reflex
5) Check eye movements
6) Do a fundoscopy ( look for optic atrophy, particularly if there is RAPD)
7) Look for a medic alert bracelet
8) Look for other features of endocrinopathy eg acromegaly, Cushing's syndrome which should also have been picked up during inspection
The other causes of a chiasmal lesion include pituitary adenoma, meningioma, aneurysm, glioma
5 comments:
as usual it is a nice and informative thread however may I remind you that you forgot inspecting the eyelids for possible ptosis or exophthalmos
would you please merge the threads of this blog and the other one together.http://pacesmrcpuk.blogspot.com/
Thanks. I am sorry I am not able to merge them together as I don't have authorization from the other website.
Do we ought to further differentiate the compression of optic chiasma is from above or below? or it is impossible as quadrantanopia has progressed to hemi?
we know that bitemporal hemianopia is caused by pituitary tumors.
can anyone tell what is the cause of binasal hemianopia?
how can you differentiate between brain lesion causing homonymous hemianopia and optic tract lesion causing homonymous hemianopia ?
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