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Chiasmal apoplexy. Report of four cases
Journal of Neurosurgery
|January 1, 1982
Insights
Intrachiasmal hematomas, often caused by vascular issues or optic gliomas, can present as suprasellar masses. Surgical intervention improved vision in most patients with these rare chiasmal syndromes.
Area of Science:
- Neuro-ophthalmology
- Neuroradiology
- Neurosurgery
Background:
- Chiasmal syndromes can arise from various pathologies affecting the optic chiasm.
- Intrachiasmal hematomas are a rare but significant cause of visual field deficits.
Observation:
- Four patients presented with chiasmal syndrome and confirmed intrachiasmal hematomas.
- Computerized tomography (CT) scans revealed high-density suprasellar masses in all evaluated cases.
- Etiologies included cryptic vascular anomalies (3 cases) and an occult optic glioma (1 case).
Findings:
- Spontaneous hemorrhage into the optic chiasm was identified as the primary cause.
- Surgical evacuation of the hematoma led to visual function improvement in three out of four patients.
- CT imaging is crucial for diagnosing these suprasellar masses.
Implications:
- Early diagnosis and surgical management of intrachiasmal hematomas can restore visual function.
- This highlights the importance of considering hematomas in the differential diagnosis of chiasmal syndromes.
- Further research into the underlying vascular anomalies may prevent future occurrences.
Abstract:
Four patients with chiasmal syndromes were found to have intrachiasmal hematomas. Computerized tomography scans showed high-density suprasellar masses in all cases. Cryptic vascular anomalies were presumed to be responsible for spontaneous bleeding into the chiasm in three of the cases. In the remaining case, hemorrhage was due to an occult optic glioma. Surgical evacuation of clotted blood resulted in improved visual function in three of the four cases.