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Chiasmal Syndrome


Presentation

  • Traumatic chismal syndrome should be considered in the differential diagnosis of patients presenting with bitemporal hemianopsia.[ncbi.nlm.nih.gov]
Galactorrhea
  • Systemic hormonal aberrations such as Cushing’s syndrome, galactorrhea and acromegaly usually predate the compressive signs. Pituitary tumors often encroach upon the middle chiasm from below.[en.wikipedia.org]
Weight Loss
  • The characteristic presentation consisted of progressive impairment of vision without headache or abnormal plain skull x-ray films in patients with weight loss or diabetes insipidus.[ncbi.nlm.nih.gov]
  • It is not known whether weight loss in DS patients is due to increased energy consumption, inadequate absorption, or both.[bmccancer.biomedcentral.com]
Macula
  • Optical coherence tomography findings also revealed subtle macular thickness beyond normal in the superior and nasal quadrants of both maculae.[ingentaconnect.com]
  • This is due to loss of retinal ganglion cells nasal to the macula in the papillomacular bundle. Compressive lesions often cause headache and may compress the third ventricle leading to hydrocephalus.[en.wikipedia.org]
Fracture
  • An orbital computed tomography scan with non-enhancement conducted at the time of the visit showed multiple frontal skull fractures and cerebromalacia a small fracture in the sphenoidal boneboth frontal lobes.[ncbi.nlm.nih.gov]
  • Computed tomography disclosed many fractures in the skull including the back wall of the sphenoid sinuses. She also suffered from diabetes insipidus and anosmia.[unboundmedicine.com]
Hemianopsia
  • Traumatic chismal syndrome should be considered in the differential diagnosis of patients presenting with bitemporal hemianopsia.[ncbi.nlm.nih.gov]
  • Traumatic bitemporal hemianopsia and diabetes insipidus. Surg Neurol 09 1978; 246[thieme-connect.com]
  • Traumatic chiasmal syndrome presenting with bitemporal hemianopsia. J Trauma 1998;44:224-9. [ PUBMED ] [Figure 1], [Figure 2] Article Access Statistics Viewed 1932 Printed 20 Emailed 0 PDF Downloaded 115 Comments [Add][ijo.in]
  • […] chiasmal syndrome: a case report. ( 30128677 ) Caporlingua A...Santoro A 2018 3 Chiasmal syndrome: Clinical characteristics in patients attending an ophthalmological center. ( 29234224 ) Astorga-Carballo A....Camargo-Suarez M.F. 2017 4 Isolated bitemporal hemianopsia[malacards.org]
Loss of Peripheral Vision
  • Symptoms may include: Involuntary eyeball movement Outward bulging of one or both eyes Squinting Vision loss in one or both eyes that starts with the loss of peripheral vision and eventually leads to blindness The child may show symptoms of diencephalic[medlineplus.gov]
  • This may present either as decreased central acuity or as a loss in peripheral visual fields. [23] Loss of Peripheral Vision Often patients are unaware of peripheral field loss; directed questions towards functional changes such as increased rate of car[eyewiki.aao.org]
Anisocoria
  • Suggests a sympathetic defect in the eye with the smaller pupil (potentially Horner's) If a patient's anisocoria is the same in dim and bright light, what does this suggest? Tht the anisocoria is physiologic.[quizlet.com]
  • Ipsilateral fixed and dilated pupil leading to Anisocoria (Affected eye is unresponsive and apparently perceiving dimmer environment with impaired consensual light reflex from the opposite eye as well).[epomedicine.com]
Lagophthalmos
  • Look for facial asymmetry, blink pattern, forehead wrinkling, lagophthalmos, and facial emotional response and response to command.[quizlet.com]
Fear
  • The supposed artifactual nature of Wilbrand's knee has implications for the degree of resection that can be obtained, namely by cutting the optic nerve immediately at the junction with the chiasm without fear of potentially resulting visual field deficits[en.wikipedia.org]
Bitemporal Hemianopsia
  • Traumatic chismal syndrome should be considered in the differential diagnosis of patients presenting with bitemporal hemianopsia.[ncbi.nlm.nih.gov]
  • Traumatic bitemporal hemianopsia and diabetes insipidus. Surg Neurol 09 1978; 246[thieme-connect.com]
  • Traumatic chiasmal syndrome presenting with bitemporal hemianopsia. J Trauma 1998;44:224-9. [ PUBMED ] [Figure 1], [Figure 2] Article Access Statistics Viewed 1932 Printed 20 Emailed 0 PDF Downloaded 115 Comments [Add][ijo.in]
  • hemianopsia due to traumatic chiasmal syndrome. ( 27135085 ) Yazici B....Kivanc S.A. 2016 5 Traumatic Chiasmal Syndrome: A Midline Axonal Injury. ( 27928365 ) Vora T.K....Ravi R.R. 2015 6 Early morphological recovery of the optic chiasm is associated[malacards.org]
Bitemporal Hemianopsia
  • Traumatic chismal syndrome should be considered in the differential diagnosis of patients presenting with bitemporal hemianopsia.[ncbi.nlm.nih.gov]
  • Traumatic bitemporal hemianopsia and diabetes insipidus. Surg Neurol 09 1978; 246[thieme-connect.com]
  • Traumatic chiasmal syndrome presenting with bitemporal hemianopsia. J Trauma 1998;44:224-9. [ PUBMED ] [Figure 1], [Figure 2] Article Access Statistics Viewed 1932 Printed 20 Emailed 0 PDF Downloaded 115 Comments [Add][ijo.in]
  • hemianopsia due to traumatic chiasmal syndrome. ( 27135085 ) Yazici B....Kivanc S.A. 2016 5 Traumatic Chiasmal Syndrome: A Midline Axonal Injury. ( 27928365 ) Vora T.K....Ravi R.R. 2015 6 Early morphological recovery of the optic chiasm is associated[malacards.org]
Motor Disturbances
  • Abstract The chiasmal syndrome has distinct ophthalmological features such as visual field loss, optic disc changes, decrease in visual acuity, ocular motor disturbances and exophthalmos.[ncbi.nlm.nih.gov]
Fixed Pupils
  • When swinging, if the right pupil does NOT remain the same size (i.e. gets larger and then constricts on each swing) there is also an APD in the fixed pupil eye.[quizlet.com]

Workup

  • Diagnosis and Workup The patient was diagnosed as a normal tension glaucoma suspect and subsequently referred to a glaucoma specialist for further evaluation and treatment.[reviewofophthalmology.com]
  • It is important to note that while a sellar mass may present with bitemporal hemianopia, the combination of findings described above describing a junctional scotoma also localizes to the sellar area, and additional workup is indicated.[webeye.ophth.uiowa.edu]
  • While a majority of patients with endogenous Cushing syndrome have thyrotrophic adenomas (called Cushing Disease - see below), other tumors should also be considered as part of the endocrinologic workup, including adrenal tumors and especially ACTH-secreting[eyewiki.aao.org]
  • It was obtained from a patient who reported visual loss and had a normal endocrine workup. The dark areas correspond to the impaired peripheral visual field. This visual field defect is consistent with an intrasellar lesion.[emedicine.medscape.com]
Enlarged Sella
  • The neuroradiological differential diagnosis of an enlarged sella turcica is given.[ncbi.nlm.nih.gov]
  • The CT and MRI scans are typical, if not diagnostic.92 MRI and CT scans distinguish between many tissue densities, and MRI can detect the presence of blood; the finding of acute or subacute bleeding within a tumor based in an enlarged sella is highly[medtextfree.wordpress.com]

Treatment

  • Pituitary adenomas are the most common cause of an optic chiasmal syndrome, and treatment of these lesions is considerably different from the treatment of most of the other lesions in this region.[ncbi.nlm.nih.gov]
  • Purpose Pituitary adenomas are the most common cause of an optic chiasmal syndrome, and treatment of these lesions is considerably different from the treatment of most of the other lesions in this region.[jhu.pure.elsevier.com]

Prognosis

  • A review of recent and relevant literature was performed to highlight chiasmal syndromes and pathology, as well as to discuss current methods of diagnosis, prognosis and considerations in the treatment of a patient presenting with a chiasmal disorder.[uthealth.influuent.utsystem.edu]
  • These tumors are slow growing and more often found children. [2] However, they have a worse prognosis, especially if they have extended into the hypothalamus. They are frequently associated with neurofibromatosis type 1 (NF-1).[en.wikipedia.org]
  • However, they have a worse prognosis, especially if they have extended into the hypothalamus. They are frequently associated with neurofibromatosis type 1 (NF-1). The vast majority of chiasmal syndromes are compressive.[wikidoc.org]
  • Patients with an optic glioma and neurofibromatosis type 1 have a better prognosis than those who do not have neurofibromatosis.[thamburaj.com]

Etiology

  • Although no single clinical feature can be used to determine the specific nature of a lesion that produces an optic chiasmal syndrome, certain features are highly suggestive of an etiology other than pituitary adenoma.[ncbi.nlm.nih.gov]
  • Conclusion Although no single clinical feature can be used to determine the specific nature of a lesion that produces an optic chiasmal syndrome, certain features are highly suggestive of an etiology other than pituitary adenoma.[jhu.pure.elsevier.com]
  • Magnetic resonance imaging is the best mode of neuroimaging for most chiasmal lesions and may also provide clues to the etiology of an isolated chiasmal syndrome. Related Topics Loading Related Articles[doi.org]

Epidemiology

  • Figure 7 : Non-contrast head CT, axial view, showing layered hemorrhages within bilateral lateral ventricles Diagnosis Compressive optic neuropathy/junctional scotoma secondary to pituitary adenoma EPIDEMIOLOGY Age and gender predilection varies depending[webeye.ophth.uiowa.edu]
  • Epidemiology INCIDENCE  1% of all intracranial tumours, 3–5% of paediatric brain tumours and 6% of all orbital tumours.  Gliomas account for two-thirds of all tumours in the optic nerve.  About 25% of OPGs are in the optic nerve [Optic nerve glioma[slideshare.net]
  • [PUBMED Abstract] Milano MT, Johnson MD, Sul J, et al.: Primary spinal cord glioma: a Surveillance, Epidemiology, and End Results database study. J Neurooncol 98 (1): 83-92, 2010.[cancer.gov]
  • […] less commonly patients may also have Ocular motility deficits and/or Diplopia, certain forms of Nystagmus, signs and symptoms of Increased intracranial pressure due to mass effect, Optic atrophy, or sequelae of Pituitary apoplexy. [3] [4] [5] General Epidemiology[eyewiki.aao.org]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiology of neurological disorders in childhood is based on the same principles of the organization, structure, and function of the nervous sys tem as apply to adults. Two pitfalls are present for the student, however.[books.google.com]
  • Pathophysiology [ edit ] Lee has divided optic chiasmal syndromes into anterior, middle and posterior locations. [6] Anterior chiasmal syndrome affects the junction of the optic nerve and chiasm.[en.wikipedia.org]
  • Pathophysiology Lee has divided optic chiasmal syndromes into anterior, middle and posterior locations 2. Anterior chiasmal syndrome affects the junction of the optic nerve and chiasm.[wikidoc.org]

Prevention

  • Clinicians should be aware of Sneddon syndrome because prompt diagnosis and treatment may prevent potential morbidity and mortality.[collections.lib.utah.edu]
  • As the pituitary tumour causes compression of the optic chiasm, tumour reduction or removal is important to prevent progressive field loss.[mrcophth.com]
  • Treatment of carpal tunnel syndrome Lock your wrist and pad from a roller as a preventive measure removes the burden on the median nerve and ligaments in the wrist.[minclinic.ru]
  • The secondary objective was to review complications of transsphenoidal surgery from the standpoint of their causation, treatment, and prevention.[scinapse.io]
  • However, in several cases, enteral or parenteral nutrition may provide to children unable to feed the nutrients necessary to ensure proper growth, to correct or prevent malnutrition [ 22 ].[bmccancer.biomedcentral.com]

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