|Year : 2023 | Volume
| Issue : 1 | Page : 124-125
Sellar mass presenting as monocular temporal hemianopia
Gurcharan Singh1, Kebede Gofer2
1 Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare, LV Prasad Eye Institute, Hyderabad, India; Liberia Eye Centre- LV Prasad Eye Institute, John F Kennedy Memorial Medical Centre, Monrovia, Liberia, West Africa
2 Department of Radiology, John F Kennedy Memorial Medical Centre, Monrovia, Liberia, West Africa
|Date of Submission||30-Mar-2022|
|Date of Acceptance||25-Aug-2022|
|Date of Web Publication||20-Jan-2023|
Liberia Eye Centre, John F Kennedy Memorial Medical Centre, Sinkor, Monrovia, - 1000, Liberia
Source of Support: None, Conflict of Interest: None
A 56-year-old male presented with diminished vision in his left eye since 6 months. Humphrey visual field examination showed monocular left eye temporal hemianopia extending onto inferonasal field. Right eye field was essentially normal. Computed tomography scan of brain and orbits showed enhancing sellar mass with extension into suprasellar area having solid and cystic components. This is a rare visual field presentation of a sellar mass.
Keywords: Craniopharyngioma, monocular temporal hemianopia, pituitary macroadenoma, sellar mass
|How to cite this article:|
Singh G, Gofer K. Sellar mass presenting as monocular temporal hemianopia. Indian J Ophthalmol Case Rep 2023;3:124-5
Monocular temporal hemianopia is an uncommon field defect of a sellar lesion. It requires the lesion to be located in a specific parachiasmal area, so as to affect only the crossing nasal fibers from the ipsilateral eye, while sparing those from the contralateral eye. Hershenfeld and Sharpe reported 24 cases of monocular temporal hemianopia, 19 of which had juxtasellar lesions. Here, we present a case of monocular temporal hemianopia in an adult male having a parasellar mass, which was most likely craniopharyngioma or pituitary macroadenoma based on radiological features.
| Case Report|| |
A 56-year-old male presented with gradual painless diminution of vision in the left eye since 6 months. His visual acuity was 20/20 and 20/400 in the right and left eyes, respectively. His intraocular pressure was normal. Color vision was normal in the right eye, and he could identify only one plate of Ishihara color plates with his left eye. Pupillary examination revealed grade 1 relative afferent pupillary defect (RAPD) in the left eye. Posterior segment examination was normal in both eyes, except for mild temporal pallor of optic disk in the left eye. Humphrey visual field (HVF) examination showed monocular left eye temporal hemianopia extending onto inferonasal field. The right eye field was essentially normal [Figure 1]. Optical coherence tomography (OCT) of optic disk cube showed retinal nerve fiber layer thinning in temporal quadrant of the left eye (which corresponded to the area nasal to macula), thus correlating with HVF, and normal retinal nerve fiber layer in the right eye [Figure 2]. Computed tomography (CT) scan of brain and orbits showed enhancing sellar mass with extension into the suprasellar area having solid and cystic components with punctate calcification. It measured about 3.77 cm craniocaudally and 2.91 cm anteroposteriorly. The solid component was hyperdense on precontrast and showed avid enhancement with contrast, and the cystic component was located posteriorly [Figure 3]. It had partially encased the distal internal carotid arteries, completely encased the left optic nerve, and separate visualization of the chiasm from the mass was difficult. It had eroded the body of sphenoid bone [Figure 3]. The possible differential diagnoses were craniopharyngioma and pituitary macroadenoma.
|Figure 1: HVF shows temporal hemianopia in the left eye and normal field in the right eye. HVF = Humphrey visual field|
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|Figure 2: OCT of optic disk showing temporal RNFL thinning in the left eye. OCT = optical coherence tomography, RNFL = retinal nerve fiber layer|
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|Figure 3: CT scan shows enhancing sellar mass with extension into suprasellar area having solid and cystic components in axial and sagittal views. Bone window shows erosion of body of sphenoid bone. CT = computed tomography|
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The patient was referred for urgent neurosurgery consult, but unfortunately was lost to follow-up.
| Discussion|| |
Monocular temporal hemianopia is an uncommon manifestation of damage to visual pathway. Such a field defect can result from asymmetric parachiasmal lesion or can be functional. Absence of RAPD and persistence of hemianopia on binocular field testing may help to identify functional cause of such field loss. Organic cause of monocular temporal hemianopia may be explained by the involvement of ipsilateral optic nerve close enough to the chiasm to selectively impair conduction in ipsilateral crossing fibers, but too anterior to affect the crossing nasal retinal fibers from the contralateral eye. Monocular field loss may be caused by asymmetric tumor growth causing differential mechanical pressure or differential occlusion of chiasmal nutrient blood vessels., Hershenfeld and Sharpe reported 24 cases of monocular temporal hemianopia, 19 of which had juxtasellar lesions, two had congenital optic disk dysversion, one had optic neuritis, and two had functional field loss. In their report, 18 patients had RAPD on the side of monocular visual field defect and six patients had normal pupils. Fundoscopy showed disk pallor in 13, normal disk in nine, and disk dysversion in two patients. Of the 24 patients, 10 patients who had monocular defect by kinetic techniques on tangent or Goldmann perimetry, on follow-up, had binocular defects on automated perimetry. Gupta et al. reported a case of pituitary macroadenoma in a pregnant woman presenting with similar field loss that improved spontaneously after delivery. Brooks and Subramanian reported similar field loss in a case of septo-optic dysplasia.
| Conclusion|| |
Sellar lesions should strongly be considered and neuroimaging obtained in cases presenting with RAPD and such field loss.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his names and initials will not be published, and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Hershenfeld SA, Sharpe JA. Monocular temporal hemianopia. Br J Ophthalmol 1993;77:424-27.
Bergland RM, Ray BS, Torack RM. Anatomical variations in the pituitary gland and adjacent structures in 225 human cases. Y Neurosurg 1968;28:93-9.
Schneider RC, Kriss FC, Falls HF. Pre-chiasmal infarction associated with intrachiasmal and suprasellar tumors. J Neurosurg 1970;32:197-208.
Bergland RM, Ray BS. The arterial supply of the human chiasm. J Neurosurg 1969;31:327-34.
Gupta A, Deshmukh M, Palexas G. Pituitary macroadenoma presenting with monocular temporal hemianopia. J Neuroophthalmol 2021;41:267-68.
Brooks DB, Subramanian PS. Monocular temporal hemianopia with septo-optic dysplasia. J Neuroophthalmol 2006;26:195-96.
[Figure 1], [Figure 2], [Figure 3]