Francesco Pellegrini1, Michele Marullo1, Antonio Zappacosta1, Tatiana Liberali1, Alessandra Cuna2, Andrew G Lee3,4,5,6,7. 1. Department of Ophthalmology, Pescara Hospital, AUSL Pescara, Pescara, Italy. 2. Department of Ophthalmology, AULSS2 Marca Trevigiana, Treviso, Italy. 3. Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA. 4. Department of Ophthalmology, UTMB, Galveston, TX, USA. 5. UT MD Anderson Cancer Center, Texas A&M College of Medicine, Houston, TX, USA. 6. Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA. 7. Departments of Ophthalmology, Baylor College of Medicine and The University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Abstract
PURPOSE: To describe a case of a suprasellar meningioma compressing the chiasm from below and producing a unilateral fascicular (nasal) visual field defect that mimicked glaucomatous cupping. CASE REPORT: A 78-year-old man presented with painless, progressive, unilateral arcuate visual field defect. He was diagnosed with "normal tension glaucoma" based on an asymmetric cup to disc ratio. Despite treatment with anti-glaucoma drops, the visual field defect progressed. Neurophthalmic evaluation was consistent with a compressive optic neuropathy OD. Brain MRI showed a suprasellar meningioma compressing on the junction of the optic nerve and chiasm from below. CONCLUSION: Although junctional visual field loss (e.g. junctional scotoma and junctional scotoma of Traquair) are well-known presentations of compressive lesions at the optic chiasm, we describe a monocular, ipsilateral compressive superior nasal defect and asymmetric cupping as the presenting sign of a junctional compressive lesion mimicking glaucomatous cupping.
PURPOSE: To describe a case of a suprasellar meningioma compressing the chiasm from below and producing a unilateral fascicular (nasal) visual field defect that mimicked glaucomatous cupping. CASE REPORT: A 78-year-old man presented with painless, progressive, unilateral arcuate visual field defect. He was diagnosed with "normal tension glaucoma" based on an asymmetric cup to disc ratio. Despite treatment with anti-glaucoma drops, the visual field defect progressed. Neurophthalmic evaluation was consistent with a compressive optic neuropathy OD. Brain MRI showed a suprasellar meningioma compressing on the junction of the optic nerve and chiasm from below. CONCLUSION: Although junctional visual field loss (e.g. junctional scotoma and junctional scotoma of Traquair) are well-known presentations of compressive lesions at the optic chiasm, we describe a monocular, ipsilateral compressive superior nasal defect and asymmetric cupping as the presenting sign of a junctional compressive lesion mimicking glaucomatous cupping.
Entities:
Keywords:
Suprasellar meningioma; altitudinal field defect; fascicular field defect; glaucoma