2002 Volume 11 Issue 7 Pages 475-478
A 44-year-old man was admitted to our hospital with symptoms of severe headaches, decreased visual acuity in right and bilateral visual field defects. Computed tomography and magnetic resonance imaging (MRI) of the brain revealed multiple high density/intensity lesions in both cerebral hemispheres. A suprasellar tumor with homogenous high intensity on Ti-weighted image and a heterogenous high intensity on T2-weighted image was demonstrated in MRI. The lesion was comfirmed angiographically as cryptic. The intraoperative findings suggested a hematoma probably originating from the suprasellar tumor compressing the right optic nerve. After removal of the tumor and hematoma, his visual acuity and field defect dramatically improved. The pathological diagnosis was cavernous angioma. The term"chiasmal apoplexy"was first used by Maitland et al. in 1982 to describe abrupt retro-orbital or frontal pain associated with visual field defect caused by acute bleeding in the optic chiasma. Our review of the recent literature suggests that the chiasmal apoplexy caused by a hemorrhagic lesion out side of the optic nerve itself is very rare. Immediate surgical removal of the lesion and hematoma seems to be the optimal choice.
