Reversible Unilateral Visual Field Defect as the Presentation of a Pituitary Adenoma and Cerebral Aneurysm

Bitemporal hemianopsia is a well known sequelae of compression of the optic chiasm, oftentimes by a pituitary tumor. Here we present a case of a patient with unilateral visual symptoms as the presenting sign of a pituitary adenoma and a large cerebral aneurysm.

Poster 19 Reversible Unilateral Visual Field Defect as the Presentation of a Pituitary Adenoma and Cerebral Aneurysm Eman Hawy1, Kaitlyn Pearson1, John Pyun1 1 Loma Linda University, Loma Linda, California, USA, Introduction: Bitemporal hemianopsia is a well known sequelae of compression of the optic chiasm, oftentimes by a pituitary tumor. Here we present a case of a patient with unilateral visual symptoms as the presenting sign of a pituitary adenoma and a large cerebral aneurysm. Description of Case(s): Our patient was a 47 year-old male without prior medical history presenting with decreased vision and photopsias in the right eye for 9 months. He was referred to neuro-ophthalmology for his unexplained decreased vision. Examination revealed decreased color vision, and a rAPD in the right eye; no deficits were identified in the left eye. On Humphrey Visual Field testing, the patient was found to have an inferotemporal deficit in the right eye that respected the vertical meridian; no corresponding deficits were found in testing of the left eye. MRI of the brain was recommended and revealed a large compressive pituitary macroadenoma and an anterior communicating aneurysm. The patient subsequently underwent urgent aneurysm coiling and tumor resection. At his post operative follow-up, the patient had improvement of his vision with full color vision and resolved rAPD. Repeat Humphrey Visual Field testing demonstrated resolution of the patient's prior inferotemporal deficit. Conclusions, including unique features of the case(s): Chiasmal compression typically presents with bitemporal visual field defects. We present a case of chiasmal compression from a pituitary macroadenomaand a large aneurysm presenting with subtle unilateral symptoms and a unilateral visual field defect. This case highlights the importance of considering a chiasmal etiology whenever a temporal visual field defect is seen, even when unilateral. We also demonstrate that early treatment can result in improvement or resolution of the visual field defect. References: Anik, I., et al. "Evaluation of Early Visual Recovery in Pituitary Macroadenomas after Endoscopic Endonasal Transsphenoidal Surgery: Quantitative Assessment with Diffusion Tensor Imaging (Dti)." Acta Neurochir (Wien) 153.4 (2011): 831-42. Print. Cohen, A. R., et al. "Visual Recovery after Transsphenoidal Removal of Pituitary Adenomas." Neurosurgery 17.3 (1985): 44652. Print. Poon, A., et al. "Patterns of Visual Loss Associated with Pituitary Macroadenomas." Aust N Z J Ophthalmol 23.2 (1995): 107-15. Print. Keywords: Neuroimaging, Visual fields, Tumors Financial Disclosures: The authors had no disclosures. Grant Support: None. Contact Information: Eman Hawy- 11370 Anderson St Loma Linda, CA 92354; [e-mail] 76 | North American Neuro-Ophthalmology Society