An-Najah Staff

Although pituitary adenoma is the most common primary tumor associated with a bitemporal hemianopsia visual field defect, little is known about the etiology of such defect in the presence of a normal neuroimaging studies. We present a 61year-old woman with symptoms of poor peripheral vision for the past two years, recent-onset double vision and eye pain that developed over a period of three months after having a stroke. Ocular examination was unremarkable with no afferent pupillary defect, muscle palsies or optic atrophy. Automated perimetry revealed a bitemporal hemianopsia defect.  Sed rate, CRP levels, and a complete blood count showed no indication of an underlying inflammatory etiology. MRI of the brain and pituitary gland revealed no evidence of pituitary adenoma or other sellar mass. No other acute abnormality was identified within the brain. An MRI of the spine revealed focal demylinating lesions. The patient was diagnosed with multiple sclerosis, and further neurological testing, with a repeat MRI, was recommended to determine the etiology of the visual field defect. This case discusses the differential diagnosis of bitemporal hemianopsia in the absence of a space-occupying lesion.