Bitemporal hemianopia

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-In-Chief:Aditya Govindavarjhulla, M.B.B.S. [2]

Synonyms and keywords: Bitemporal hemianopsia

Overview

Bitemporal hemianopia is a specific type of visual disturbance in which sight in the outer half of the visual field of each eye is lost. As a result, the patient retains central vision but loses sight at the edges of his or her vision. This is not always obvious to a patient because one tends to focus conscious attention more on objects in the center of the visual field.

Hemianopia signifies a loss of half of the visual field, and bitemporal denotes the two lateral, or temporal, sides of the head. By contrast, homonymous hemianopia signifies that the same half of each visual field is lost, ie all vision on the left, or on the right, of the midline. Such a pattern of visual loss is caused by damage to the more distal part of the optic radiation, most commonly by a stroke. "Bitemporal hemianopia" can be broken down as follows: bi-: involves both left and right visual fields, temporal: involves the temporal visual field, hemi-: involves half of each visual field and anopsia: blindness (formed by a(n) no + opsis vision + ia).

Historical Perspective

  • First case of Bitemporal hemianopsia was reported by Clarence A. Veasey, in 1904 [1].
  • In 1929, L. S. KUBIE, M.D. and J. W. BECKMANN, M.D. documented Diplopia to be the most reported symptom in patients with bitemporal hemianopia in the absence of extraocular muscle palsies.[2]

Classification

  • Bitemporal hemianopia may be classified according to the number of defective optic fibers into complete bitemporal hemianopia and partial bitemporal hemianopia.

Pathophysiology

Causes

Most of the common causes of bitemporal hemianopia are due to disorders of the pituitary gland and its surrounding structures.

Common Causes

Causes by Organ System

Cardiovascular No underlying causes
Chemical / poisoning No underlying causes
Dermatologic Dermatochalasis[11]
Drug Side Effect Chloroquine retinopathy[12], Ethambutol toxicity[13]
Ear Nose Throat No underlying causes
Endocrine Pituatary macroadenoma, Prolactinoma
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic No underlying causes
Infectious Disease No underlying causes
Musculoskeletal / Ortho No underlying causes
Neurologic Craniopharyngioma, Aneurysm of anterior communicating artery, Intracranial vascular loop, Meningioma, Enlarged third ventricle[14], Glioma of third ventricle[15], Chronic chiasmal arachnoiditis[16], Suprasellar tumors[17][14][13][13][13][13][13][13], Adamantinoma of sella turcica[17], Optic neuropathy[13][8][7][7][7][7][7][7], Traumatic chiasmal syndrome[18], Dolichoectasia of internal carotid arteries[19]
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic Hypophyseal hypertrophy in pregnancy[20]
Oncologic Adamantinoma of sella turcica, Craniopharyngioma, Glioma of third ventricle, Pituitary macroadenoma, Prolactinoma, Meningioma, Suprasellar tumors
Opthalmologic Dermatochalasis, Optic neuropathy, Optic chiasmal syndrome, Bilateral blepharoptosis[21], Traumatic chiasmal syndrome, Retinal disorders[22], Nasal Staphylomata [23], Tilted disc syndrome[24]
Overdose / Toxicity Ethambutol toxicity
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal / Electrolyte No underlying causes
Rheum / Immune / Allergy No underlying causes
Sexual No underlying causes
Trauma Traumatic chiasmal syndrome
Urologic No underlying causes
Dental No underlying causes
Miscellaneous No underlying causes

Differentiating Bitemporal hemianopia from other Diseases

Risk Factors

  • There are no established risk factors for Bitemporal hemianopia.

Screening

  • There is insufficient evidence to recommend routine screening for Bitemporal hemianopia.

Natural History, Complications, and Prognosis

References

  1. Veasey CA (1904). "Observations of a case of bi-temporal hemianopsia with some unusual changes in the visual fields". Trans Am Ophthalmol Soc. 10 (Pt 2): 383–7. PMC 1322445. PMID 16692037.
  2. Kubie, L. S.; Beckmann, J. W. (1929). "DIPLOPIA WITHOUT EXTRA-OCULAR PALSIES, CAUSED BY HETERONYMOUS DEFECTS IN THE VISUAL FIELDS ASSOCIATED WITH DEFECTIVE MACULAR VISION". Brain. 52 (3): 317–333. doi:10.1093/brain/52.3.317. ISSN 0006-8950.
  3. "The Retinotopic Representation of the Visual Field - Neuroscience - NCBI Bookshelf".
  4. Hedges TR (1969). "Preservation of the upper nasal field in the chiasmal syndrome: an anatomic explanation". Trans Am Ophthalmol Soc. 67: 131–41. PMC 1310336. PMID 5381296.
  5. Bergland R (1969). "The arterial supply of the human optic chiasm". J Neurosurg. 31 (3): 327–34. doi:10.3171/jns.1969.31.3.0327. PMID 5811834.
  6. McIlwaine GG, Carrim ZI, Lueck CJ, Chrisp TM (2005). "A mechanical theory to account for bitemporal hemianopia from chiasmal compression". J Neuroophthalmol. 25 (1): 40–3. doi:10.1097/00041327-200503000-00011. PMID 15756133.
  7. Lake MG, Krook LS, Cruz SV (2013). "Pituitary adenomas: an overview". Am Fam Physician. 88 (5): 319–27. PMID 24010395.
  8. Müller HL (2014). "Craniopharyngioma". Endocr Rev. 35 (3): 513–43. doi:10.1210/er.2013-1115. PMID 24467716.
  9. Bejjani GK, Cockerham KP, Kennerdell JS, Maroon JC (2002). "Visual field deficit caused by vascular compression from a suprasellar meningioma: case report". Neurosurgery. 50 (5): 1129–31, discussion 1131-2. doi:10.1097/00006123-200205000-00033. PMID 11950417.
  10. Seung WB, Kim DY, Park YS (2015). "A Large Ruptured Anterior Communicating Artery Aneurysm Presenting with Bitemporal Hemianopsia". J Korean Neurosurg Soc. 58 (3): 291–3. doi:10.3340/jkns.2015.58.3.291. PMC 4630364. PMID 26539276.
  11. Fay A, Lee LC, Pasquale LR (2003). "Dermatochalasis causing apparent bitemporal hemianopsia". Ophthalmic Plast Reconstr Surg. 19 (2): 151–3. doi:10.1097/01.IOP.0000055827.78632.CA. PMID 12644764.
  12. Goldhammer, Y.; Smith, J. L. (1974). "Bitemporal hemianopia in chloroquine retinopathy". Neurology. 24 (12): 1135–1135. doi:10.1212/WNL.24.12.1135. ISSN 0028-3878.
  13. 13.0 13.1 Boulanger Scemama E, Touitou V, Le Hoang P (2013). "[Bitemporal hemianopia as presenting sign of severe ethambutol toxicity]". J Fr Ophtalmol. 36 (9): e163–7. doi:10.1016/j.jfo.2012.12.008. PMID 24094504.
  14. Osher, R. H.; Corbett, J. J.; Schatz, N. J.; Savino, P. J.; Orr, L. S. (1978). "Neuro-ophthalmological complications of enlargement of the third ventricle". British Journal of Ophthalmology. 62 (8): 536–542. doi:10.1136/bjo.62.8.536. ISSN 0007-1161.
  15. Thavaratnam LK, Loy ST, Gupta A, Ng I, Cullen JF (2015). "Chordoid glioma". Singapore Med J. 56 (11): 641–3. doi:10.11622/smedj.2015175. PMC 4656874. PMID 26668411.
  16. GIBBS DC (1959). "Chiasmal arachnoiditis". Br J Ophthalmol. 43 (1): 52–6. doi:10.1136/bjo.43.1.52. PMC 512211. PMID 13618533.
  17. 17.0 17.1 Lodge WO (1946). "BITEMPORAL HEMIANOPIA". Br J Ophthalmol. 30 (5): 276–81. PMC 510604. PMID 18170220.
  18. Yazici, Bulent (2015). "Isolated Bitemporal Hemianopsia Due to Traumatic Chiasmal Syndrome". Turkish Journal of Trauma and Emergency Surgery. doi:10.5505/tjtes.2015.90540. ISSN 1306-696X.
  19. Slavin ML (1990). "Bitemporal hemianopia associated with dolichoectasia of the intracranial carotid arteries". J Clin Neuroophthalmol. 10 (1): 80–1. PMID 2139057.
  20. PEARCE HM (1963). "PHYSIOLOGIC BITEMPORAL HEMIANOPSIA IN PREGNANCY". Obstet Gynecol. 22: 612–4. PMID 14082282.
  21. Levine BM, Lelli GJ (2010). "Bitemporal hemianopia caused by bilateral blepharoptosis". Orbit. 29 (6): 351–3. doi:10.3109/01676830.2010.516467. PMID 21158577.
  22. "Bitemporal Hemianopia Caused by Retinal Disease". Archives of Ophthalmology. 127 (12): 1686. 2009. doi:10.1001/archophthalmol.2009.320. ISSN 0003-9950.
  23. Gupta, Anjali; Smith, J. M. Alaric (2015). "Bitemporal Hemianopia Secondary to Nasal Staphylomata". Journal of Neuro-Ophthalmology. 35 (1): 99–101. doi:10.1097/WNO.0000000000000202. ISSN 1070-8022.
  24. Manfrè L, Vero S, Focarelli-Barone C, Lagalla R (1999). "Bitemporal pseudohemianopia related to the "tilted disk" syndrome: CT, MR, and fundoscopic findings". AJNR Am J Neuroradiol. 20 (9): 1750–1. PMC 7056191 Check |pmc= value (help). PMID 10543654.
  25. Peli E, Satgunam P (2014). "Bitemporal hemianopia; its unique binocular complexities and a novel remedy". Ophthalmic Physiol Opt. 34 (2): 233–42. doi:10.1111/opo.12118. PMC 3947624. PMID 24588535.
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  28. Lampropoulos KI, Samonis G, Nomikos P (2013). "Factors influencing the outcome of microsurgical transsphenoidal surgery for pituitary adenomas: a study on 184 patients". Hormones (Athens). 12 (2): 254–64. doi:10.14310/horm.2002.1409. PMID 23933694.
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  32. Vellayan Mookan L, Thomas PA, Harwani AA (2018). "Traumatic chiasmal syndrome: A meta-analysis". Am J Ophthalmol Case Rep. 9: 119–123. doi:10.1016/j.ajoc.2018.01.029. PMC 5861742. PMID 29577103.

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