Traumatic bitemporal hemianopia.
A 45-year-old male pedestrian was struck by a motor vehicle moving at high speed. Upon initial assessment, the patient scored a 3T on the Glasgow Coma Scale. The patient suffered multiple facial and sinus fractures, a right orbital wall fracture, and a depressed open frontal skull fracture with visible brain parenchyma. Due to the nature of the brain injury, the patient was taken to the operating room emergently for a right frontal craniectomy. The patient required prolonged hospitalization followed by transfer to a rehabilitation facility. Six weeks after the accident, the patient underwent an extensive neuro-ophthalmologic evaluation. At that time, visual acuity was 20/200 in both eyes. On visual field testing, a bitemporal hemianopia was noted. Ophthalmoscopic examination revealed bilateral temporal disc pallor, right greater than left. Neuroimaging demonstrated damage to the optic chiasm. Although rare, head trauma may cause a bitemporal hemianopia secondary to optic chiasmal injury.
Marriott
Elizabeth
E
Loyola University Medical Center, Maywood, IL 60153, USA.
Jay
Walter M
WM
D000063:Accidents, Traffic; D004569:Electroencephalography; D005597:Fractures, Open / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D005624:Frontal Bone / Q000293:injuries; D006423:Hemianopsia / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma; D009917:Orbital Fractures / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D015599:Trauma Severity Indices; D014792:Visual Acuity; D058609:Visual Field Tests; D014794:Visual Fields