Junctional scotoma from a sellar mass

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Identifier EEC-Junctional_Scotoma-NOVEL
Title Junctional scotoma from a sellar mass
Subject junctional scotoma, optic nerve, optic chiasm, pituitary adenoma
Creator Jonathan A. Micieli, MD, Department of Ophthalmology, Emory University School of Medicine; Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
Description This is a case of a 55-year-old woman presenting with gradual painless vision loss in both eyes. Although visual acuity was 20/20 in both eyes, there was a left relative afferent pupillary defect and diffuse pallor of both optic nerves (Figure 1). Visual fields (24-2 SITA-Fast) showed a temporal defect in the right eye and more diffuse loss in the left eye respecting the vertical meridian superiorly (Figure 2). The visual field defect localizes to the distal portion of the optic nerve at the angle of the chiasm and is called a junctional scotoma (Figure 3). Optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) showed thinning superiorly in the right eye and more diffusely in the left eye (Figure 4 and 5). OCT of the ganglion cell layer (GCL) showed nasal loss in the right eye corresponding to the temporal visual field defect and more diffuse loss of macular ganglion cells in the left eye with relative sparing of the infero-temporal macula corresponding to the diffuse visual field loss with relative sparing of the supero-nasal visual field (Figure 6). MRI showed compression of the left pre-chiasmatic optic nerve and chiasm by a pituitary adenoma (Figure 7). The most common cause of a junctional scotoma, as shown in this case, is a mass such as a neoplasm or aneurysm. [[ Number of Figures and legend for each: 7 figures included. Figure 1. Optic disc photos at presentation showed diffuse pallor in both eyes. Figure 2. Visual fields (24-2 SITA-Fast) showed a temporal defect in the right eye and more diffuse loss in the left eye respecting the vertical meridian superiorly. Figure 3. The visual field defect localized to the distal portion of the optic nerve at the angle of the chiasm and is called a junctional scotoma. Figure 4. Optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) showed thinning superiorly in the right eye and more diffusely in the left eye. Figure 5. Optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) showed thinning superiorly in the right eye and more diffusely in the left eye. Figure 6. OCT of the ganglion cell layer (GCL) showed nasal loss in the right eye corresponding to the temporal visual field defect and more diffuse loss of macular ganglion cells in the left eye with relative sparing of the infero-temporal macula corresponding to the diffuse visual field loss with relative sparing of the supero-nasal visual field. Figure 7. Coronal T2 MRI sequences are shown demonstrating compression of the left pre-chiasmatic optic nerve and chiasm by a pituitary adenoma.]]
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Date 2018-01
Format application/pdf
Rights Management Copyright 2018. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
Collection Neuro-ophthalmology Virtual Education Library: NOVEL http://NOVEL.utah.edu
Language eng
ARK ark:/87278/s6f51mbk
Setname ehsl_novel_eec
Date Created 2018-01-09
Date Modified 2018-02-21
ID 1291692
Reference URL https://collections.lib.utah.edu/ark:/87278/s6f51mbk
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