Tumor de hipófise em paciente com hidrocefalia: um desafio diagnóstico / Pituitary tumor in a patient with hydrocephalus: a diagnostic challenge

RESUMO A hidrocefalia é definida como a dilatação ventricular pelo aumento da pressão intraventricular e intracraniana quando não tratada ou por insucesso do tratamento. Muitas vezes, leva ao dano das vias ópticas, podendo causar atrofia óptica, devido à proximidade dessas vias com o ventrículo lateral quando ocorre a dilatação. Assim como a hidrocefalia pode levar à atrofia óptica, outras patologias também podem. Tumores hipofisários compartilham desse mesmo sinal, além de causar hemianospsia bitemporal quando o tumor comprime quiasma óptico. Ademais, a hemianopsia bitemporal é o distúrbio visual mais comum encontrado em pacientes com tumor de hipófise. Os tumores de hipófise, por exemplo, geram manifestações clínicas que podem estar relacionadas à disfunção da glândula ou aos efeitos mecânicos da expansão tumoral. Sinais e sintomas visuais estão mais ligados ao efeito mecânico do tumor. Assim, muitas vezes, o paciente procura o oftalmologista antes do endocrinologista. Neste caso, analisaremos uma paciente portadora de hidrocefalia que apresentava, concomitantemente, um tumor hipofisário, e a investigação oftalmológica fez toda a diferença no tratamento da paciente.

ABSTRACT Hydrocephalus is defined as ventricular dilation caused by increased intraventricular and intracranial pressure when untreated or due to treatment failure. Optical pathways can often cause optic atrophy due to the proximity to the lateral hazard when dilation occurs. Hydrocephalus can lead to optic atrophy, as well as other pathologies. Pituitary tumors share this same sign, in addition to causing bitemporal hemianopia when it compresses the optic chiasm. In addition, bitemporal hemianopia is the visual disturbance most commonly found in patients with pituitary tumors. Pituitary tumors, for example, have clinical manifestations that may be related to gland dysfunction, or to mechanisms of tumor expansion. Visual signs and symptoms are more linked to the mechanical effect of the tumor. Therefore, the patient usually seeks the ophthalmologist before the endocrinologist. In this case, we analyzed a patient with hydrocephalus who presented, at the same time, a pituitary tumor, and the ophthalmological investigation made all the difference in the treatment of the patient.

Manifestaciones neuroftalmológicas en pacientes con enfermedad cerebrovascular isquémica / Neuro-ophthalmological manifestations in patients with ischemic cerebrovascular disease

La enfermedad cerebrovascular isquémica tiene una elevada incidencia y prevalencia en Cuba, y constituye la tercera causa de muerte en el país. Existen diferencias anatómicas y clínicas entre el infarto de la circulación anterior y la posterior. En ocasiones, los elementos distintivos que ayudan al diagnóstico topográfico de la enfermedad cerebrovascular isquémica son las manifestaciones neuroftalmológicas. Con el objetivo de profundizar en el conocimiento actual sobre las alteraciones neuroftalmológicas que se asocian a la enfermedad cerebrovascular isquémica, se realizó una revisión bibliográfica, donde se consultaron un total de 69 fuentes de información digital de los últimos 5 años. La circulación cerebral se divide de manera general en anterior y posterior. Los síntomas y signos principales del ictus que afecta la circulación anterior son la desviación conjugada de la mirada, la afectación de las sácadas, la hemianopsia homónima, la heminegligencia y la apraxia de la apertura ocular; mientras que las alteraciones asociadas a la afectación de la circulación posterior son el nistagmo, las anormalidades en la alineación y los movimientos oculares, así como la hemianopsia homónima con conservación macular. Se concluye que en la enfermedad cerebrovascular isquémica aparecen síntomas y signos como consecuencia de la afectación, tanto de la vía visual aferente, como de la eferente. La hemianopsia homónima es el signo más frecuente reportado(AU)

Ischemic cerebrovascular disease has a high incidence and prevalence in Cuba, and it is the third cause of death in the country. A number of anatomical and clinical differences distinguish anterior from posterior circulation infarction. On certain occasions the distinguishing elements that aid in the topographic diagnosis of ischemic cerebrovascular disease are its neuro-ophthalmological manifestations. With the purpose of gaining insight into the current knowledge about the neuro-ophthalmological alterations associated to ischemic cerebrovascular disease, a bibliographic review was conducted based on the analysis of 69 digital information sources from the last five years. Cerebral circulation is generally divided into anterior and posterior. The main symptoms and signs of the stroke that affects anterior circulation are conjugate gaze deviation, altered saccades, homonymous hemianopsia, heminegligence and eyelid opening apraxia, whereas the alterations associated to posterior circulation involvement are nystagmus, eye movement and alignment abnormalities, and homonymous hemianopsia with macular preservation. It is concluded that ischemic cerebrovascular disease presents symptoms and signs related to both the afferent and the efferent visual pathways. Homonymous hemianopsia is the most common sign reported(AU)

Traumatic chiasmal syndrome. Case report / Síndrome quiasmática traumática. Relato de caso

ABSTRACT Traumatic chiasmal syndrome is one of the rare etiologies of chiasmal syndrome, characterized by optic chiasm injury following head trauma. The main visual defect associated is bitemporal hemianopia with macular splitting; however, it can present with a variety of other visual defects and neurologic signs. The authors report a case of complete bitemporal hemianopia after head trauma, with multiple frontal and skull base fractures and no other neurologic deficits, or hypothalamic-pituitary abnormality. Most cases of traumatic chiasmal syndrome are caused by mechanical stretch or compression of the chiasma. Nevertheless, in this case, the radiologic findings excluded macroscopic disruption or external compression of the chiasma, raising the possibility of a contusion necrosis associated with functional impairment of the optic chiasma. Traumatic chiasmal syndrome must be considered in the differential diagnosis of patients presenting with complete bitemporal hemianopia after head injury caused by frontal and skull base fracture.

RESUMO A síndrome quiasmática traumática é uma das raras etiologias da síndrome do quiasma óptico, que se caracteriza pela presença de lesão do quiasma óptico causada por traumatismo craniencefálico. O principal defeito visual associado é a hemianopsia bitemporal com macular splitting. No entanto, pode se manifestar por uma variedade de outros defeitos visuais e sinais neurológicos. Os autores relatam um caso de hemianopsia bitemporal completa após traumatismo craniencefálico com múltiplas fraturas frontais e da base do crânio na ausência de outros défices neurológicos ou alterações do eixo hipotálamo-hipofisário. A maioria dos casos de síndrome quiasmática traumática é causada por estiramento mecânico ou compressão do quiasma. No entanto, no caso apresentado, os achados radiológicos excluíram lesão macroscópica ou compressiva do quiasma, levantando a possibilidade de uma necrose após contusão associada ao compromisso funcional do quiasma óptico. A síndrome quiasmática traumática deve ser considerada no diagnóstico diferencial de doentes que apresentam hemianopsia bitemporal completa após traumatismo craniencefálico, especialmente em casos de fratura do osso frontal e da base do crânio.

Return to Work Assessment in a Radiographer Assistant Suffering a Hemianopsia due to an Ischemic Stroke

@#Return to work assessment (RTWA) has been performed to a radiographer assistant suffering a hemianopsia due to an ischemic stroke. Stroke occurred two months prior to the examination. The general condition of the patient was good. The systemic examination was unremarkable except the presence of a partial vision loss in the left eye and often feeling fatigue and down. Perimetry Full-field 120 Point Screening Test confirmed a left temporal hemianopsia while Patient Health Questionnaire’s score (PHQ-9) indicated a moderate depression. The two conditions were not fully compatible with the job demand of a radiographer assistant, which required a complete and clear visual field as well as a good mental status. Risk assessment indicated that the patient might encounter health and safety issues if he resumed duty without work adjustment. The clinic still wanted to employ the patient and agreed to provide support. The patient was declared ‘fit’ to resume his duty with some recommendations.

Left Homonymous Hemianopsia as the First Presentation of Left Atrial Mass

We report the case of an 81-year-old man with sudden incomplete left hemianopsia. Brain computed tomography (CT) showed a right occipital hypodensity which did not seem related to the consequences of embolic stroke as atrial fibrillation consequence (the patients suffered from permanent atrial fibrillation, CHA2DS2-VASc score=5, but rather showed the characteristics of ischemic lesion due to other causes. Therefore, diagnostic work up was performed and revealed advanced non-small cell lung cancer invading left atrium through upper pulmonary veins. No others secondary lesions were detected. Cardiac involvement in cancer is an unusual finding in clinical practice and rarely stroke is the first manifestation. There are no reported cases of neoplastic embolism to the brain from cancer in the left atrium whose origin is into the lung. The patient started palliative chemotherapy. This report highlights the need for a holistic approach in medicine as the obvious diagnosis could not be the right one.

Bilateral Occipital Lobe Infarction Presenting as Bilateral Inferior Altitudinal Defects

PURPOSE: Horizontal visual field defects are generally caused by lesions before the optic chiasm, but we report a case with bilateral inferior altitudinal defects secondary to bilateral occipital lobe infarction. CASE SUMMARY: A 57-year-old male with a history of diabetes and hypertension presented with a month of blurring in the inferior visual field. His corrected visual acuity was 1.0 in the right eye and 0.63 in the left eye, and the intraocular pressure was normal in each eye. Pupillary response, ocular movement, and color vision tests were normal in both eyes. There was no specific finding of the optic disc and macula on fundus examination. Visual field examination revealed an inferior congruous homonymous hemianopia with horizontal meridian sparing and a left incongruous homonymous quadrantanopia. Optical coherence tomography for peripapillary retinal nerve fiber layer thickness revealed a mild decrease in the inferior disc of both eyes. Brain magnetic resonance imaging confirmed the presence of an acute infarction confined with upper medial calcarine fissures of bilateral occipital lobe and the right splenium of the corpus callosum, which were consistent with inferior altitudinal hemianopia and left superior incongruous quadrantanopia, respectively. Brain magnetic resonance angiography showed multiple stenosis of bilateral posterior cerebral arteries. CONCLUSIONS: The altitudinal visual field defects could be caused by the occipital lesion medial to the calcarine fissure, and unusual visual defects could be due to a combination of multiple lesions.

Homonymous Quadrantanopia Caused by Occipital Lobe Ulegyria

PURPOSE: We report a case of homonymous quadrantanopia caused by occipital lobe ulegyria. CASE SUMMARY: A 23-year-female was referred to our clinic because of a visual field defect incidentally discovered during preoperative evaluation for refractive surgery at another clinic. However, she did not report any symptoms. She had no systemic diseases. Visual acuity was 20/20 in both eyes, and the color vision test was normal. Both pupils exhibited normal responses to light and near stimulations. In fundus examinations, the right optic disc was normal and the left contained drusen. Automated perimetry revealed right lower homonymous quadrantanopia with macular sparing. Brain magnetic resonance imaging revealed areas of ulegyria involving the left occipital lobe, consistent with the visual field defect. A follow-up visual field test performed 5 months later yielded the same result. CONCLUSIONS: Neuroimaging should be performed in patients with homonymous visual field defects to determine the location and etiology of the brain lesions. Occipital lobe ulegyria can cause homonymous quadrantanopia in the absence of any neurological problem.

Posterior Type of Alzheimer's Dementia Presenting with Homonymous Hemianopsia

BACKGROUND: Alzheimer's disease is a chronic neurodegenerative condition, mostly affecting the medial temporal lobe and associated neocortical structures. In this report, we present a rare clinical manifestation of this disease. CASE REPORT: A 61-year-old female with word finding difficulty and memory disturbances was diagnosed with Alzheimer's disease. Two years later, she complained of right homonymous hemianopia without optic ataxia, ocular apraxia, and simultagnosia. No findings other than parenchymal disease were apparent in magnetic resonance imaging and laboratory tests. CONCLUSIONS: In this case, in a patient initially diagnosed with Alzheimer's dementia with progressive disease, we found only homonymous hemianopia, without signs of Balint's syndrome or Gerstmann's syndrome. After careful investigation showing that Alzheimer's dementia with visual symptom was not associated with parenchymal disease, we concluded a case of atypical variant of Alzheimer's disease.

Caso de hemianopsia reversível no pós-parto decorrente de síndrome da encefalopatia reversível posterior (PRES) em gestante com eclâmpsia tardia / Reversible hemianopsia in postpartum due to posterior reversible encephalopathy syndrome in pregnant with late eclampsia

Resumo Objetivos: Descrever um caso de Síndrome da Encefalopatia Reversível Posterior em gestante diagnosticada com eclâmpsia tardia, bem como seu manejo clínico. Descrição do caso: Paciente feminina, 34 anos, em sua terceira gestação, iniciou com aumento dos níveis tensionais durante o trabalho de parto e, após onze dias de puerpério, apresentou quadro de diminuição da acuidade visual à direita, seguida de crise convulsiva e subsequente perda parcial da visão do olho direito. Após a realização de exames de imagem e descartada a possibilidade de acidente vascular encefálico, a paciente foi diagnosticada com Síndrome da Encefalopatia Reversível Posterior (PRES). Instituído o manejo clínico das crises convulsivas e hipertensivas, houve remissão completa dos sintomas e reversão do quadro clínico inicial. Conclusões: Uma vez adequadamente diagnosticada e tratada, a Síndrome da Encefalopatia Reversível Posterior pode apresentar evolução satisfatória, especialmente quando associada a um fator desencadeado agudamente, como a eclâmpsia.

Abstract Objectives: To describe a case of Posterior Reversible Encephalopathy Syndrome diagnosed in pregnant women with late-eclampsia, as well as its clinical management. Case description: A 34 years old patient in her third pregnancy had started with high blood pressure levels during labor; after eleven days postpartum, she presented a decreased right visual acuity; subsequently one episode of seizure followed by partial loss of vision in the right eye. After conducting tests and ruled out stroke, the patient was diagnosed as Posterior Reversible Encephalopathy Syndrome (PRES). Established the clinical management of seizures and hypertensive crisis, there was complete remission of symptoms and reversal of the initial clinical picture. Conclusion: Once properly diagnosed and treated, the Posterior Reversible Encephalopathy Syndrome can present satisfactory progress, especially when associated with an acutely triggered factor, as eclampsia.

Occipital Lobe Epilepsy with Hemicrania Epileptica

No abstract available.

Dysfunction of visual spatial attention in occipital stroke patients with hemianopia during the acute phase / 中华神经科杂志

Objective To investigate the visual spatial attention of occipital stroke patients with hemianopia during the acute phase.Methods Eight occipital stroke patients with homonymous hemianopia of left side in the acute stage and 10 age-matched healthy controls were recruited to examine the capability of visual spatial attention.The cue-target paradigms were applied in this behavioral research.Results In the repeated measures analysis of variance,the difference of group and cue range had distinct main effect in reaction time and accuracy rate,while the difference of target location only had main effect in reaction time.Compared with the control group,the patients exhibited longer reaction time ((1 628.26 ± 183.97) ms vs (839.79±61.29) ms,F(1,16) =163.706,P＜0.05) and lower accuracy rate (73.40％ ±3.12％ vs 92.99％ ±0.76％,F(1,16) =371.850,P ＜ 0.05).The patients displayed lower accuracy rate under large cue than small cue (71.38％ ±3.35％ vs 75.42％ ±4.23％,F(1,7) =6.706,P ＜0.05),while that of healthy controls did not vary under different cue range(93.01％ ± 0.50％ vs 92.96％ ± 1.42％,F(1,9) =0.010,P ＞ 0.05).The patients showed longer reaction time in blind-side target than healthy-side target ((1 664.17±196.57) msvs (1 594.35±174.45) ms,F(1,7) =14.157,P＜0.05),while that of control group in two target location had no statistically significant difference ((839.67 ± 60.41) ms vs (839.91 ±73.54) ms,F(1,9) =0.000,P ＞0.05).Furthermore,the mean reaction time of stroke patients had a negative correlation with the binocular vision field index (r =-0.824,P ＜ 0.05).Conclusions The extent of vision field loss in occipital stroke patients with hemianopia can reflect impairment of visual spatial attention during the acute phase.The rehabilitation training should emphasize promoting recovery of visual spatial attention in the blind side under large cue.

Bitemporal Hemianopsia in Ethambutol-Induced Optic Neuropathy

PURPOSE: To report three cases with bitemporal hemianopsia after using ethambutol to treat tuberculosis. CASE SUMMARY: A 50-year-old male with chronic renal failure and tuberculous pleurisy, a 57-year-old male with diabetic retinopathy and pulmonary tuberculosis, and a 59-year-old male with diabetes and pulmonary tuberculosis were referred for evaluation due to decreased visual acuity for several months after taking ethambutol to treat tuberculosis. All 3 patients had abnormal color vision and visual evoked potential in both eyes. Visual field showed bitemporal hemianopsia with or without central scotoma. Brain imaging tests were normal. Although ethambutol was discontinued in all three patients, one patient with renal disease showed further decrease in visual acuity and visual field worsened to total field defect. CONCLUSIONS: Ethambutol-induced optic neuropathy is a wide spectrum disorder and based on our cases, can present as bitemporal hemianopsia mimicking compressive chiasmal lesions. A thorough history should be taken and immediate discontinuation of ethambutol is recommended in cases when bitemporal hemianopia occurs.

A Large Ruptured Anterior Communicating Artery Aneurysm Presenting with Bitemporal Hemianopsia

Anterior communicating artery (ACoA) aneurysms sometimes present with visual symptoms when they rupture or directly compress the optic nerve. Giant or large ACoA aneurysms producing bitemporal hemianopsia are extremely rare. Here we present an unusual case of bitemporal hemianopsia caused by a large intracranial aneurysm of the ACoA. A 41-year-old woman was admitted to our neurosurgical department with a sudden-onset bursting headache and visual impairment. On admission, her vision was decreased to finger counting at 30 cm in the left eye and 50 cm in the right eye, and a severe bitemporal hemianopsia was demonstrated on visual field testing. A brain computed tomography scan revealed a subarachnoid hemorrhage at the basal cistern, and conventional cerebral catheter angiography of the left internal carotid artery demonstrated an 18x8 mm dumbbell-shaped aneurysm at the ACoA. Microscopic aneurysmal clipping was performed. An ACoA aneurysm can produce visual field defects by compressing the optic chiasm or nerves. We emphasize that it is important to diagnose an aneurysm through cerebrovascular study to prevent confusing it with pituitary apoplexy.

Sudden Hemianopsia Secondary to Ethmoid Sinus Mucocele

Paranasal sinus mucoceles are benign cystic lesions, filled with mucus, occurring due to an obstruction of involved sinus ostium. They are indolent, locally expansive, and destructive. Surgical treatment must be performed and, when done at the correct time, may prevent sequelae. We present a case of ethmoid sinus mucocele with orbit involvement and permanent optical nerve injury...

Internal Carotid Artery Aneurysm Presenting with Unilateral Nasal Hemianopsia

PURPOSE: To report a case of unilateral nasal hemianopsia caused by a large internal carotid artery aneurysm. CASE SUMMARY: A 56-year-old female presented with large cupping in the left optic nerve head detected incidentally during a routine check-up. She had no underlying systemic disease except hypertension. The best corrected visual acuity was 20/20 in both eyes and a slit-lamp examination showed no abnormal findings. Ophthalmoscopy showed cup/disc ratios of 0.6 in the right eye and 0.75 in the left eye. Relative afferent papillary defect or color vision defect was not observed. A Humphrey visual-field test indicated unilateral nasal hemianopsia in the left eye. Brain CT and angiography revealed a large 2.2-cm aneurysm on the left internal carotid artery. CONCLUSIONS: Internal carotid artery aneurysm should be considered as a possible cause of unilateral nasal hemianopsia in patients without intraocular lesion.

Hemianopsia homônima como síndrome clínica isolada com alto potencial deconversão para esclerose múltipla / Homonymous hemianopia as an isolated clinical syndrome with high potential for conversion to multiple sclerosis

Introdução: A hemianopsia homônima ocorre apenas na presença de lesão retroquiasmática, sendo uma rara apresentação de doença desmielinizante. Objetivo: Relatar um caso raro de hemianopsia homônima como manifestação inicial de síndrome clinicamente isolada. Método: Foi realizada uma revisão de 809 prontuários médicos de pacientes com esclerose múltipla (EM) tratados no Hospital da Lagoa (Rio de Janeiro) entre 1995 e 2011, para identificação de casos de hemianopsiahomônima como manifestação inicial da doença. Relato de caso: Paciente do sexo feminino, 48 anos, apresentou em agosto de 2011 quadro de hemianopsia homônima esquerda incongruente associada à lesão em topografia do trato óptico direito, evidenciada na RM de crânio, que também revelou lesões periventriculares e em substância branca subcortical, compatíveis com doença desmielinizante. O exame do líquido cefalorraquidiano (LCR) revelou hiperproteinemia leve com síntese intratecal de IgG e IgM, e o estudo do potencial visual evocado mostrou comprometimento parcial das vias ópticas bilateralmente. Concluído o diagnóstico de síndrome clinicamente isolada, a paciente foi submetida à pulsoterapia com metilprednisolona, com remissão das queixas visuais e melhora acentuada do campo visual no segundo exame realizado. O diagnóstico de EM foi concluído em dezembro de 2011, com o resultado da segunda RM, que revelou redução no tamanho da lesão em topografia do trato óptico direito e persistência das lesões focais periventriculares e subcorticais, com o surgimento de novas lesões frontais captantes de contraste. Conclusão: Embora a neurite óptica seja a manifestação ocular mais frequente da síndrome clinicamente isolada, deve-se estar atento a outras formas atípicas de apresentação para que se possa fazer um diagnóstico precoce. Os defeitos de campo visual na EM geralmente têm bom prognóstico com o tratamento adequado...

Introduction: Homonymous hemianopia occurs only in the presenceof retrochiasmatic injury, being a rare presentation of demyelinatingdisease. Objective: To report a rare case of homonymoushemianopia as the initial manifestation of clinically isolated syndrome.Method: We conducted a review of medical records of 809 patientswith multiple sclerosis (MS) treated at Hospital da Lagoa (Rio de Janeiro) between 1995 and 2011, being found only one case of homonymous hemianopia as the initial manifestation of the disease. Case report: Female patient, 48 years old, presented in August 2011 incongruous left homonymous hemianopia associated with lesion in topography of the right optic tract evidenced in MRI, which also revealed lesions in periventricular and subcortical white matter, consistent with demyelinating disease. CSF revealed mild hyperproteinemia with intrathecal synthesis of IgG and IgM, and visual evoked potential study showed partial compromise of the optic pathways bilaterally. Completed the diagnostic of clinically isolated syndrome, the patient underwent pulse therapy with methylprednisolone, with remission of visual complaints and marked improvement of the visual in the second examination performed. The diagnosis of MS was completed in December 2011 with the result of the second MRI, which revealed a reduction in the lesion size in the right optic tract topography and persistence of periventricular and subcortical focal lesions, with theemergence of new frontal lesions uptake of contrast. Conclusion:Although optic neuritis is the most common ocular manifestation ofclinically isolated syndrome, we should be mindful of other atypicalforms of presentation so that we can make an early diagnosis. Thevisual defects in MS usually have a good prognosis with appropriatetreatment...

Visual Field Relocation and Clinical Effect of Fresnel Prism in Patients with Homonymous Hemianopsia

PURPOSE: To report the result of Fresnel prism application and adaptation for visual field relocation and functional vision improvement in homonymous hemianopsia patients. METHODS: Fifteen homonymous hemianopsia patients were prescribed Fresnel prism. To expand the visual field, Fresnel prism was placed base-out toward the defective field and patients were given an adaptation period of 1 month. The effects of the prism on field expansion was evaluated using Goldmann perimetry. In addition, the NEI-VFQ25 questionnaire was utilized asking patients regarding their subjective functional vision and satisfaction in daily life before and after using the Fresnel prism. RESULTS: After 1 month of Fresnel prism prescription, 53% of patients showed objective visual field expansion to the defective field of 12.5 degrees on average. Monocular or macular splitting hemianopsia patients showed more visual field expansion than binocular macular sparing hemianopsia patients. The NEI-VFQ25 score increased significantly and abnormal head position decreased or disappeared after 1 month of using the prism. However, 47% of patients failed to adapt to the prism. CONCLUSIONS: Using Fresnel prism in homonymous hemianopsia patients effectively expands the visual field, corrects abnormal head position, and improves functional vision. However, to improve the success rate, for certain patients the proper choice of prism application method, prism diopters, and constant management are necessary.

Temporary homonymous hemianopsia after epidural blood patch

We describe a case in which homonymous hemianopsia developed abruptly following an epidural blood patch procedure. The procedure was performed in a patient complaining of post-dural puncture headache after an emergency Cesarean section under spinal anesthesia. Computed tomography and magnetic resonance imaging demonstrated that air bubbles had moved from the prepontine and premedullar cisterns toward the left retrochiasmal region. The homonymous hemianopsia resolved rapidly with conservative management including oxygen, intravenous fluid, and antibiotics. We report on this case with a brief review of the related literature.

Manejo optométrico de baja visión asociada a macroadenoma hipofisiario / Optometric management of low vision associated to pituitary macroadenoma

El macroadenoma hipofisiario es un tumor de diámetro superior a 10 mm ubicado en la hipófisis, con una prevalencia del 0,20 % en población viva no seleccionada. Las manifestaciones clínicas incluyen alteraciones visuales tales como defectos en el campo visual (CV) debidos al desplazamiento del quiasma óptico de su posición inicial. La prevalencia de los defectos del CV varía del 32 % al 96 % y generalmente se encuentra hemianopsia bitemporal. Estos pacientes raramente se manejan de manera itegral y son considerados como pacientes con baja visión según la OMS. De aquí la importancia del conocimiento del manejo optpmétrico integral en estos casos.

Pituitary adenoma is a tumor with a diameter greater than 10 mm located in the pituitary gland, with a prevalence of 0.20 % in unselected living population. Clinical manifestations include visual disturbances such as visual field defects due to displacement of the optic chiasm from its normal position. The prevalence of visual field defects varies from 32% to 96%, and bitemporal hemianopsia is typically found. These lesions rarely have a full recovery, and so these patients are categorized as low vision patients according to the World Health Organization; hence the importance of knowing what the optometrist intervention and management are in such cases.

Isolated homonymous hemianopsia due to presumptive cerebral tubercular abscess as the initial manifestation of human immunodeficiency virus infection.

We report a case of isolated homonymous hemianopsia due to presumptive cerebral tubercular abscess as the initial manifestation of human immunodeficiency virus (HIV) infection. A 30-year-old man presented to our outpatient department with sudden loss of visibility in his left visual field. He had no other systemic symptoms. Perimetry showed left-sided incongruous homonymous hemianopsia denser above the horizontal meridian. Magnetic resonance imaging revealed irregular well-marginated lobulated lesions right temporo-occipital cerebral hemisphere and left high fronto-parietal cerebral hemisphere suggestive of brain tubercular abscess. Serological tests for HIV were reactive, and the patient was started only on anti-tubercular drugs with the presumptive diagnosis of cerebral tubercular abscess. Therapeutic response confirmed the diagnosis. Atypical ophthalmic manifestations may be the initial presenting feature in patients with HIV infection. This highlights the need for increased index of suspicion for HIV infection in young patients with atypical ophthalmic manifestations.