Bitemporal hemianopia
Template:DiseaseDisorder infobox
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-In-Chief:Aditya Govindavarjhulla, M.B.B.S. [2]
Synonyms and keywords: Bitemporal hemianopsia
Overview
Bitemporal hemianopia is a specific type of visual disturbance in which sight in the outer half of the visual field of each eye is lost. As a result, the patient retains central vision but loses sight at the edges of his or her vision. This is not always obvious to a patient because one tends to focus conscious attention more on objects in the center of the visual field.
Hemianopia signifies a loss of half of the visual field, and bitemporal denotes the two lateral, or temporal, sides of the head. By contrast, homonymous hemianopia signifies that the same half of each visual field is lost, ie all vision on the left, or on the right, of the midline. Such a pattern of visual loss is caused by damage to the more distal part of the optic radiation, most commonly by a stroke. "Bitemporal hemianopia" can be broken down as follows: bi-: involves both left and right visual fields, temporal: involves the temporal visual field, hemi-: involves half of each visual field and anopsia: blindness (formed by a(n) no + opsis vision + ia).
Historical Perspective
- First case of Bitemporal hemianopsia was first reported by Clarence A. Veasey, in 1904 [1].
Classification
- Bitemporal hemianopia may be classified according to the number of defective optic fibers into complete bitemporal hemianopia and partial bitemporal hemianopia.
Pathophysiology
- Bitemporal hemianopia is a visual defect due to a lesion involving optic chiasm.
- While afferent sensory inputs from superior temporal quadrant of visual field are relayed through inferior nasal fibers of optic nerve, the inputs from inferior temporal quadrant are relayed through superior nasal fibers. Similarly the visual information from superior nasal quadrant and inferior nasal quadrant are relayed through inferior temporal fibers and superior temporal fibers respectively .
- Optic chiasm is an anatomical structure in middle cranial fossa formed by decussation of nasal fibers of optic nerve travelling from retina to visual cortex.
- A lesion involving optic chiasm either due to compression (eventually leading to vascular compromise) or vascular compromise, disrupts nasal fibers of optic nerve almost always resulting in bilateral defects in temporal half of visual field.[2]
- A lesion compressing the chiasm from below (eg: pitutary tumors) will have predominant defects in superior temporal quadrants along with partial defects in inferior temporal quadrant and Vice-versa.
Causes
Most of the common causes of bitemporal hemianopia are due to disorders of the pituitary gland and its surrounding structures.
Common Causes
Causes by Organ System
| Cardiovascular | No underlying causes |
| Chemical / poisoning | No underlying causes |
| Dermatologic | Dermatochalasis[5] |
| Drug Side Effect | Chloroquine retinopathy[6], Ethambutol toxicity[7] |
| Ear Nose Throat | No underlying causes |
| Endocrine | Pituatary macroadenoma, Prolactinoma |
| Environmental | No underlying causes |
| Gastroenterologic | No underlying causes |
| Genetic | No underlying causes |
| Hematologic | No underlying causes |
| Iatrogenic | No underlying causes |
| Infectious Disease | No underlying causes |
| Musculoskeletal / Ortho | No underlying causes |
| Neurologic | Craniopharyngioma, Aneurysm of anterior communicating artery[8], Intracranial vascular loop, Meningioma[9], Enlarged third ventricle[10], Glioma of third ventricle[11], Chronic chiasmal arachnoiditis[12], Suprasellar tumors[13][13][13][13][13], Adamantinoma of sella turcica[13], Optic neuropathy[7][7][7][7][7], Traumatic chiasmal syndrome[14], Dolichoectasia of internal carotid arteries[15] |
| Nutritional / Metabolic | No underlying causes |
| Obstetric/Gynecologic | Hypophyseal hypertrophy in pregnancy[16] |
| Oncologic | Adamantinoma of sella turcica, Craniopharyngioma, Glioma of third ventricle, Pituitary macroadenoma, Prolactinoma, Meningioma, Suprasellar tumors |
| Opthalmologic | Dermatochalasis, Optic neuropathy, Optic chiasmal syndrome, Bilateral blepharoptosis[17], Traumatic chiasmal syndrome |
| Overdose / Toxicity | Ethambutol toxicity |
| Psychiatric | No underlying causes |
| Pulmonary | No underlying causes |
| Renal / Electrolyte | No underlying causes |
| Rheum / Immune / Allergy | No underlying causes |
| Sexual | No underlying causes |
| Trauma | Traumatic chiasmal syndrome |
| Urologic | No underlying causes |
| Dental | No underlying causes |
| Miscellaneous | No underlying causes |
Related Chapters
References
- ↑ Veasey CA (1904). "Observations of a case of bi-temporal hemianopsia with some unusual changes in the visual fields". Trans Am Ophthalmol Soc. 10 (Pt 2): 383–7. PMC 1322445. PMID 16692037.
- ↑ Hoyt WF (1970). "Correlative functional anatomy of the optic chiasm. 1969". Clin Neurosurg. 17: 189–208. doi:10.1093/neurosurgery/17.cn_suppl_1.189. PMID 4939481.
- ↑ Lake MG, Krook LS, Cruz SV (2013). "Pituitary adenomas: an overview". Am Fam Physician. 88 (5): 319–27. PMID 24010395.
- ↑ Müller HL (2014). "Craniopharyngioma". Endocr Rev. 35 (3): 513–43. doi:10.1210/er.2013-1115. PMID 24467716.
- ↑ Fay A, Lee LC, Pasquale LR (2003). "Dermatochalasis causing apparent bitemporal hemianopsia". Ophthalmic Plast Reconstr Surg. 19 (2): 151–3. doi:10.1097/01.IOP.0000055827.78632.CA. PMID 12644764.
- ↑ Goldhammer, Y.; Smith, J. L. (1974). "Bitemporal hemianopia in chloroquine retinopathy". Neurology. 24 (12): 1135–1135. doi:10.1212/WNL.24.12.1135. ISSN 0028-3878.
- ↑ 7.0 7.1 Boulanger Scemama E, Touitou V, Le Hoang P (2013). "[Bitemporal hemianopia as presenting sign of severe ethambutol toxicity]". J Fr Ophtalmol. 36 (9): e163–7. doi:10.1016/j.jfo.2012.12.008. PMID 24094504.
- ↑ Seung WB, Kim DY, Park YS (2015). "A Large Ruptured Anterior Communicating Artery Aneurysm Presenting with Bitemporal Hemianopsia". J Korean Neurosurg Soc. 58 (3): 291–3. doi:10.3340/jkns.2015.58.3.291. PMC 4630364. PMID 26539276.
- ↑ Bejjani GK, Cockerham KP, Kennerdell JS, Maroon JC (2002). "Visual field deficit caused by vascular compression from a suprasellar meningioma: case report". Neurosurgery. 50 (5): 1129–31, discussion 1131-2. doi:10.1097/00006123-200205000-00033. PMID 11950417.
- ↑ Osher, R. H.; Corbett, J. J.; Schatz, N. J.; Savino, P. J.; Orr, L. S. (1978). "Neuro-ophthalmological complications of enlargement of the third ventricle". British Journal of Ophthalmology. 62 (8): 536–542. doi:10.1136/bjo.62.8.536. ISSN 0007-1161.
- ↑ Thavaratnam LK, Loy ST, Gupta A, Ng I, Cullen JF (2015). "Chordoid glioma". Singapore Med J. 56 (11): 641–3. doi:10.11622/smedj.2015175. PMC 4656874. PMID 26668411.
- ↑ GIBBS DC (1959). "Chiasmal arachnoiditis". Br J Ophthalmol. 43 (1): 52–6. doi:10.1136/bjo.43.1.52. PMC 512211. PMID 13618533.
- ↑ 13.0 13.1 Lodge WO (1946). "BITEMPORAL HEMIANOPIA". Br J Ophthalmol. 30 (5): 276–81. PMC 510604. PMID 18170220.
- ↑ Yazici, Bulent (2015). "Isolated Bitemporal Hemianopsia Due to Traumatic Chiasmal Syndrome". Turkish Journal of Trauma and Emergency Surgery. doi:10.5505/tjtes.2015.90540. ISSN 1306-696X.
- ↑ Slavin ML (1990). "Bitemporal hemianopia associated with dolichoectasia of the intracranial carotid arteries". J Clin Neuroophthalmol. 10 (1): 80–1. PMID 2139057.
- ↑ PEARCE HM (1963). "PHYSIOLOGIC BITEMPORAL HEMIANOPSIA IN PREGNANCY". Obstet Gynecol. 22: 612–4. PMID 14082282.
- ↑ Levine BM, Lelli GJ (2010). "Bitemporal hemianopia caused by bilateral blepharoptosis". Orbit. 29 (6): 351–3. doi:10.3109/01676830.2010.516467. PMID 21158577.