Recurrent chiasmal apoplexy due to cavernous malformation

Area of Science:

• Neuro-ophthalmology
• Vascular Neurology
• Neurosurgery

Background:

• Chiasmal apoplexy is a rare condition causing sudden visual loss.
• Cavernous malformations (CMs) are congenital vascular anomalies that can hemorrhage.
• The optic chiasm is a critical structure for vision, making lesions here particularly impactful.

Observation:

• A case of chiasmal apoplexy secondary to a cavernous malformation (CM) in a pregnant patient is presented.
• Initial visual recovery was nearly complete despite delayed surgery due to advanced pregnancy.
• Recurrent hemorrhage from the CM occurred, prompting surgical intervention.

Findings:

• Surgical extirpation of the CM was performed after recurrent hemorrhage.
• The patient experienced a residual visual deficit post-surgery.
• Literature review indicates nearly half of chiasmal CM cases involve recurrent hemorrhages.
• The association between CM hemorrhage and pregnancy is statistically rare, precluding causal conclusions.

Implications:

• This case highlights the potential for spontaneous visual recovery in chiasmal apoplexy, even with delayed surgical intervention.
• Recurrent hemorrhage is a significant risk in patients with chiasmal CMs, underscoring the need for careful monitoring and timely management.
• The management of chiasmal CMs during pregnancy presents unique challenges, balancing maternal and fetal well-being with visual preservation.