Chiasmal apoplexy due to ruptured cavernous hemangioma of the optic chiasm

A 30-year-old obese patient with a rapidly progressing chiasmal syndrome presented with acute bitemporal hemianopia, severe bilateral amblyopia, mental confusion, and lethargy. X-ray films of the skull showed a normal sella turcica and computed tomography scan as well as angiography revealed a vascular mass within the chiasmatic cistern. At operation, via left subfrontal approach, an intrachiasmal hematoma was evacuated and biopsies of the hematoma cavity revealed a cavernous hemangioma. Visual symptoms improved markedly postoperatively. This rare association of chiasmal apoplexy and intrachiasmal cavernoma is discussed.