Unusual etiology of bilateral acute visual impairment: Optochiasmatic cavernoma haemorrhage

Optochiasmatic cavernoma haemorrhage is unusual etiology of bilateral acute visual impairment. This vascular hamartoma is extremely rare with a prevalence rate of 0.4-0.9% of the general population. They are frequently revealed by an optochiasmal apoplexy. We present the case of a 38 year old woman admitted to the emergency department for bilateral acute visual impairment, associated with frontal headaches. A brain MRI led to the diagnosis of an optochiasmatic cavernoma haemorrhage. Because of the rareness, and the lack of knowledge regarding the natural history of this lesion, surgical resection is the preferred management option in most reported cases. However after clear and detailed explanations of the surgical procedure as well as the risk of visual loss our patient refused to undergo any interventions. So our attitude was to carry out a close follow-up. After one year the visual evolution was satisfactory, no clinical worsening has been noticed and the MRIs examinations showed the same aspect with the same size. The aim of this observation is to evoke the diagnosis of an optochiasmatic cavernoma haemorrhage in case of acute chiasmal compression syndrome within patients in the third and fourth decades.