Traumatic chiasmal syndrome associated with pneumocephalus and sellar fracture

A 50-year-old man sustained severe head injury, including a brief loss of consciousness, in an automobile accident. Skull X-ray films disclosed a fracture of the right superior orbit. Computed tomography demonstrated pneumocephalus and extension of the fracture into the sella turcica. Perimetric testing disclosed a bitemporal hemianopia along the vertical meridian. Visual acuity was 6/6 (20/20) in both eyes. Right macular sparing and left macular splitting were demonstrated by Amsler grid analysis as well as by the patient's description of target grids projected onto his maculas. Diplopia was attributed to direct grids projected onto his maculas. Diplopia was attributed to direct injury of the right superior rectus muscle and to the effect of bitemporal field loss. There was no evidence of pituitary dysfunction. No treatment of the patient's visual loss was undertaken. A six-month follow-up examination disclosed no change in the patient's visual field abnormalities.