MENSTRUAL IRREGULARITY AND BITEMPORAL HEMIANOPIA A 50-year-old…

Question MENSTRUAL IRREGULARITY AND BITEMPORAL HEMIANOPIA A 50-year-old… MENSTRUAL IRREGULARITY AND BITEMPORAL HEMIANOPIA A 50-year-old woman went to an ophthalmologist because of several months of worsening vision that had begun to interfere with her driving. Past history was notable for long-standing menstrual irregularity and infertility. Exam was normal except for decreased vision primarily in the temporal portions of the visual fields bilaterallyThe key symptoms and signs in this case are: • Bitemporal hemianopia • Long-standing menstrual irregularity and infertility Bitemporal hemianopia is usually caused by lesions of the optic chiasm Note that in this patient, like many patients with optic chiasm lesions, the bitemporal hemiopia is not perfectly symmetrical. The history of a menstrual irregularity and infertility suggests an endocrine disorder, which further supports the diagnosis of a lesion in the vicinity of both the pituitary gland and the optic chiasm. The most likely diagnosis is a pituitary adenoma . Other tumors or masses in the sellar and suprasellar region, including a meningioma, craniopharyngioma, optic or hypothalamic glioma, lymphoma, or sarcoid, could also produce these abnormalities. A brain MRI (Image 11.3A,B, page 482) revealed a homogeneously enhancing mass in the suprasellar region, compressing the optic chiasm. Note that the mass had a “dural tail,” suggesting that it arose from the meninges. The patient was referred to a neurosurgeon and was admitted for resection of the mass. The operative approach was through the right frontal and temporal bones. Cerebrospinal fluid was drained from the lumbar cistern, causing the lateral ventricles to collapse partly, thus making the frontal lobes easier to gently lift away from the tumor. The mass was seen to arise from the dura of the diaphragma sellae and the anterior sphenoid bone. All visible portions of the tumor were resected with careful preservation of the adjacent vasculature, optic nerves, and infundibular stalk. Pathologic sections revealed a meningioma. Following surgery the patient made an excellent recovery, with near complete return of vision in her lateral fields over the course of 6 to 7 months. Brain MRI Showing a Meningioma of the Suprasellar Region Compressing the Optic Chiasm (A) Coronal T1-weighted image showing meningioma located just dorsal to the pituitary and compressing the optic chiasm from below. (B) Sagittal T1-weighted image with intravenous gadolinium contrast enhancement, showing characteristic features of a meningioma, including relatively uniform contrast enhancement, location adjacent to the meninges, and a tapering extension along the dural surface (“dural tail”). As in (A), the tumor can be seen to compress the optic chiasm from below. All the information are provided on the case above:Can you answer the following questions in this order by reading the case above, also available in the book Neuroanatomy through clinical cases 2 nd edition by Blumenfeld.Please answer in this orderPrimary symptomsAssessmentsDiagnostic studiesDiagnosisWhat other considerations for making treatment choices?Please provide references can be online or books….many medical webstes.Thank you Health Science Science Nursing NURS 388 Share QuestionEmailCopy link Comments (0)