Case #18: MRI brain and brainstem, 10/30/92: Pituitary adenoma impinging on optic chiasm.
CC: Superior bitemporal incongruous hemianopia discovered by local optometrist on routine exam.
HX: This 47 y/o RHM presented to his local optometrist in 9/92 for routine evaluation. He had no complaint of visual loss, HA, nausea/vomiting, lymphadenopathy, weight change, galactorrhea, impotence, temperature intolerance, hot or cold flashes, or personality change. Visual field testing revealed a superior bitemporal incongruous hemianopia and he was referred to NeuroOpthalmology at UIHC.
EXAM: Vital signs: unremarkable. Visual acuity with correction: 20/40-1 OD and 20/40 OS.
No RAPD, Confrontational visual fields were full to finger counting and there was no red desaturation. EOM were full OU. No nystagmus. Goldmann visual fields revealed a superior bitemporal defect. Slit lamp exam was unremarkable. Intraocular pressures were normal (OD 11, and OS 11). Optic discs were sharp and pink bilaterally with cup:disc ratio: 0.5OD and 0.4OS. The rest of the neurological and general physical exam was unremarkable.
LABS: General Screen, CBC, TSH, FT4, PRL were unremarkable.
MRI Brain and Brainstem with & without contrast, 10/30/92 revealed a 2cm x 2cm x 3cm mass in the pituitary fossa. The mass has low signal intensity on T1 weighted images. There is enhancement of the periphery of the mass on the post-gadolinium images. The mass causes marked superior displacement of the optic chiasm; this most likely accounts for the bitemporal visual field defect. The findings were felt to be most consistent with a pituitary adenoma.
COURSE: The patient underwent uncomplicated transphenoidal resection of the pituitary lesion on 11/18/92. Pathological analysis was consistent with pituitary adenoma. NeuroOpthalmological follow-up exam on 4/2/93 showed resolution of the visual field defect. Visual acuity improved to 20/20 OD and 20/16 OS.
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