Schizencephaly Suspected as Normal Tension Glaucoma on Ophthalmoscopic Examination

ABSTRACT

PURPOSE: Occasionally, in nonglaucomatous optic atrophy, the optic nerve head may appear to be cupped to such a degree that normal tension glaucoma is suspected. We report such a case of visual field defects from schizencephaly in a patient initially suspected to have normal tension glaucoma, using ophthalmoscopic examination only. METHODS: An 18-year-old male patient visited our clinic because of bilateral visual disturbance which had developed 5 years previously. Ophthalmoscopic examination revealed an increased cup to disc ratio, peripapillary atrophy, and loss of temporal neuroretinal rim tissue. The authors suspected normal tension glaucoma in both eyes. However, because the patient was too young and the visual field test revealed atypical field defects of the left superior quadrants in both eyes, we performed MRI. The results showed right schizencephaly with an absence of septum pellucidum. In order to rule out hypothalamic- pituitary dysfunction which can coexist with the absence of septum pellucidum, we conducted combined pituitary function test (cocktail test) which revealed normal results. RESULTS: The patient was initially suspected to have normal tension glaucoma on ophthalmoscopic examination alone. However, because the patient was too young and showed nonglaucomatous visual field defects, MRI was performed and revealed right schizencephaly.