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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]
  • When these features are present, the likelihood that a suprasellar lesion is a pituitary adenoma is much lower, regardless of the appearance on neuroimaging.[ncbi.nlm.nih.gov]
  • Abstract A patient with pituitary-sellar disproportion, a perichiasmal visual field defect, and no clinically demonstrable endocrinopathy is presented.[ncbi.nlm.nih.gov]
  • Diabetes insipidus was present in half of these patients, but unlike the visual abnormalities, this complication was transient.[ncbi.nlm.nih.gov]
  • Abstract A 69-year-old white female with past medical history of follicular cell lymphoma presented to her local physician with new neurological findings.[ncbi.nlm.nih.gov]
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]
  • Radiologic studies demonstrated fractures in the fronto-ethmoid and sphenoid bones and thinning of the optic chiasm. No hypothalamic-pituitary abnormality was detected. Clinical findings remained unchanged during follow-up.[ncbi.nlm.nih.gov]
  • Computed tomographic scan showed fracture of the sella turcica. A carotid angiography showed a traumatic pseudoaneurysm of the internal carotid at the base of the skull.[ncbi.nlm.nih.gov]
  • Two-thirds had skull fractures. Three-quarters of patients had a final visual acuity of 6/12 or better in at least one eye. Ten patients had a complete optic nerve palsy. The incidence of diabetes insipidus in this study was 37%.[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]
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]
  • There was panhypopituitarism on endocrine testing and visual field examination showed inexorably progressive loss to bitemporal hemianopsia.[ncbi.nlm.nih.gov]
  • Traumatic chiasmal syndrome presenting with bitemporal hemianopsia. J Trauma 1998;44:224-9. [ PUBMED ] [Figure 1] , [Figure 2] Article Access Statistics Viewed 1790 Printed 18 Emailed 0 PDF Downloaded 113 Comments [Add][ijo.in]
  • […] chiasmal syndrome: A meta-analysis. ( 29577103 ) Vellayan Mookan L....Harwani A.A. 2018 2 Chiasmal syndrome: Clinical characteristics in patients attending an ophthalmological center. ( 29234224 ) Astorga-Carballo A....Camargo-Suarez M.F. 2017 3 Isolated bitemporal[malacards.org]
  • ., suggesting repeatable bitemporal hemianopsias. A 120-point visual field was then taken, which verified a bitemporal hemianopsia. The 24-2 visual fields were repeated two additional times over the next five months. 2.[reviewofoptometry.com]
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]

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 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]
  • 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]
Suppression
  • It remains to be seen whether hormonal manipulation aimed at suppression of gonadotropin- and/or prolactin-secreting cells might obviate the need for exploration in patients similar to ours.[ncbi.nlm.nih.gov]

Treatment

  • 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.[ncbi.nlm.nih.gov]
  • The presence of chiasmal field defects associated with the clinical syndrome of compressive optic neuropathy should not rule out the diagnosis of sphenoethmoid mucocele since definitive treatment can be carried out via transnasal drainage.[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]
  • With conservative treatment, the visual fields of the two patients are showing progressive improvement. We report here two cases of suspected arteriosclerotic optic chiasmal syndrome.[ncbi.nlm.nih.gov]
  • The most common cause of ICS appears to be optochiasmal arachnoiditis which occasionally developed some time after a craniotomy and radiation therapy for pituitary or other juxta-sellar tumors; similar fibrotic change may develop following steroid treatment[ncbi.nlm.nih.gov]

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]
  • […] choice for assessing septo-optic dysplasia. may show a "point down" appearance of the lateral ventricular frontal horns on coronal images absent septum pellucidum hypoplastic pituitary stalk hypoplastic optic chiasm/optic nerves and globes Treatment and prognosis[radiopaedia.org]

Etiology

  • 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.[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]
  • CONCLUSIONS: A clinically detectable relative afferent pupillary defect may be absent in unilateral optic nerve pallor and/or visual field loss and does not preclude the need to attempt to identify an underlying etiology.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: This review article discusses the etiology, diagnosis, and management of chiasmal syndrome.[ncbi.nlm.nih.gov]
  • 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]
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]
  • It brings together the pathophysiology of disease with detailed clinical guidance on diagnosis and management for the full range of childhood cancers, including aspects important in optimal supportive care.[books.google.ro]
  • Get a quick and memorable overview of anatomy, pathophysiology, and clinical presentation from the precision and beauty of Netter and Netter-style plates that highlight key neuroanatomical and neurologic concepts.[books.google.ro]

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]
  • 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]
  • A parasellar meningioma is a potential mimic of the pituitary adenoma, but has a comparatively harder texture, preventing it from compressing at the diaphragma sella, and therefore no “snowman” appearance.[webeye.ophth.uiowa.edu]

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