| OCR Text |
Show / ouTnal of Clinical NeuTo- ophthallllolosy Jl)( J): 80- 81. 1990. Neuro- Ophthalmic Feature Photo Bitemporal Hemianopia Associated with Dolichoectasia of the Intracranial Carotid Arteries Michael L. Slavin, M. D. © 1990 Raven Press, Ltd.. ;' Jew York Slowly progressive visual loss with bitemporal hemianopia is the hallmark of chiasmal compressive syndromes. Specific causes of the chiasmal syndrome include pituitary adenoma with suprasellar extension, suprasellar meningioma, craniopharyngioma, and, less frequently, aneurysm of the supraclinoid carotid artery. I recently saw a case in which a progressive chiasmal visual field defect was associated with dolichoectasia of the intracranial carotid arteries. A 73- year- old hypertensive woman noticed progressive visual loss in her right eye, nonspecific : no LEFT 20/ 30 FIG. 1. Perimetry ( Goldmann) reveals bitemporal hemianopia typical of optic chias-mal dysfunction. From the Division of Neuro- ophthalmology, Department of Ophthalmology, Long Island Jewish Medical Center, New Hyde Park, and the School of Medicine, Health Sciences Center, State University of New York at Stony Brook, Stony Brook, New York, U. S. A. Address correspondence and reprint requests to Dr. M. Slavin, Department of Ophthalmology, Long Island Jewish Medical Center, New Hyde Park. NY 111142. tiC, !\ 80 BITEMPORAL HEMIANOPIA 81 FIG. 2. Computed axial tomography after i. v. contrast at the level of the suprasellar cistern. Note the marked enlargement of the internal carotid arteries ( IC) that lie on each side of the optic chiasm. There is also fusiform enlargement of the middle cerebral ( MG), basilar ( B), and anterior cerebral ( A) arteries. intermittent frontal headaches, and difficulty with a sense of smell over 9 months. On neuroophthalmic examination, visual acuities were 20/ 50 right and 20/ 30 left with normal color vision. A 1+ right afferent pupil defect was seen. Visual fields ( Goldmann) revealed a pattern of bitemporal hemianopia ( Fig. 1). Fundi were normal except for subtle temporal pallor of the right optic disc. Her sense of smell was diminished to tea leaves and cologne. Computed tomography ( CT) of the suprasellar area showed atherosclerotic enlargement of the intracranial carotid arteries ( dolichoectasia) ( Fig. 2). The basilar artery as well as the middle cerebral arteries were also abnormal. Conservative treatment was recommended, and vision was stable 6 months after. Ectasia of cerebral arteries is a rare cause of the chiasmal syndrome ( 1,2). It is unclear whether the visual disturbance is due to a compressive effect ( as most likely is the cause with neoplasia and aneurysm) or to ischemia from thrombosis of branches of the abnormal parent arteries ( 3). Dolichoectasia ( or fusiform aneurysm) should be distinguished from focal arterial enlargement due to saccular ( or berry) aneurysms. Diagnosis of the former may often be made with CT or magnetic resonance imaging without angiographic confirmation. REFERENCES 1. Hilton GF, Hoyt WF. An arteriosclerotic chiasmaI syndrome: bitemporal hemianopia associated with fusiform dilatation of the anterior cerebral arteries. lAMA 1966; 196: 1018- 20. 2. Matsuo K, Kobayashi S, Sugita K. Bitemporal hemianopsia associated with sclerosis of the intracranial internal carotid arteries. I Neurosurg 1980; 53: 566-- 9. 3. Lee KF, Schatz NJ, Savino PJ. Ischemic chiasmal syndrome. In: Glaser JS, Smith JL, eds. Neuro- ophthalmology. Symposium of the University of Miami and the Bascom Palmer Eye Institute. Volume VIII. St. Louis: CV Mosby, 1975: 115- 130. I Clin Neuro- ophthalmol, Vol. 10, No. 1, 1990 |
