Chiasmal apoplexy [Neurosurgery Wiki]

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====== Chiasmal apoplexy ======


Acute visual disturbance, headache, nausea, and retroorbital pain, collectively known as “chiasmal apoplexy,” represent the most commonly encountered symptoms among [[Optic chiasma cavernous malformation]] patients


Regli et al. present a patient who experienced sudden onset of orbital headache, visual loss and bitemporal visual field defect. MRI of the optic chiasm suggested a diagnosis of haemorrhage and hence a vascular malformation. Pterional craniotomy revealed an intrachiasmatic haematoma with a cavernous angioma. The malformation was totally excised and vision improved after surgery. The syndrome of chiasmal apoplexy is discussed
((Regli L, de Tribolet N, Regli F, Bogousslavsky J. Chiasmal apoplexy:
haemorrhage from a cavernous malformation in the optic chiasm. J Neurol Neurosurg
Psychiatry. 1989 Sep;52(9):1095-9. PubMed PMID: 2795081; PubMed Central PMCID:
PMC1031747.
)).
----
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
((Maitland CG, Abiko S, Hoyt WF, Wilson CB, Okamura T. Chiasmal apoplexy. Report
of four cases. J Neurosurg. 1982 Jan;56(1):118-22. PubMed PMID: 7054405.
)).