The slow-growing nature of these tumors tends to cause optic atrophy before the tumor enlarges sufficiently to compress the third ventricle or produce sufficient mass effect to increase intracranial pressure (ICP). In the example provided in Fig. This is called Wilbrands knee and is responsible for the junctional scotoma in lesions of the posterior optic nerve. This is because more fibers in the optic tract come from the opposite eye, having crossed in the chiasm. Nonsolid tumors (macrocystic and macrohemorrhagic) have been suggested to be more effectively managed with transsphenoidal hypophysectomy in comparison with solid tumors.[34]. Bedside visual field testing is quick and easy but has relatively poor reliability, depending on the patients ability to identify and describe the visual field defect. Ali K. Pract Neurol 2015;15:5355. What are the findings of a temporal lobe lesion? Occlusion of the PCA often results homonymous hemianopia of the contralateral visual field with macular sparing. They tend to be macroadenomas at time of clinical diagnosis due to the subtle manifestations of excess growth hormone. Most isolated congruent homonymous hemianopias are due to an occipital infarction in the territory of the posterior cerebral artery (PCA). Extraocular muscle paresis may also suggest Pituitary apoplexy, which must considered in the setting of rapidly progressive vision loss and diplopia. This is performed radiographically with CT or MRI. 3.3). Cushing syndrome describes the assortment of physiologic changes that occurs with elevated serum cortisol levels. Diagnosis is clinical. Lesions of the optic radiations typically produce a contralateral homonymous hemianopia, worse superiorly when the lesion is in the temporal lobe and worse inferiorly when the lesion is in the parietal lobe. Humphrey visual field 24-2 showing a bitemporal hemianopsia. The temporal visual field falls on the nasal retina. 6. Place the patients head on a chin rest in front of a computer screen. Best Practice No 172: Pituitary Gland Pathology. Neuro-ophthalmology Illustrated-2nd Edition. Does the visual field defect involve one eye or two eyes?

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