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Purpose: Traumatic injury to the optic chiasm is rare and most frequently caused by high-velocity head trauma. It classically results in bitemporal hemianopsia and often presents in conjunction with multiple other traumatic injuries, such as skull fractures and cerebrospinal fluid leaks. We present the case of a 40-year-old woman with pre-existing thyroid orbitopathy who struck her forehead after a fall from standing height. Observations: This patient suffered immediate profound unilateral vision loss from traumatic optic neuropathy and possible optic nerve avulsion. The fellow eye manifested a temporal hemianopsia with delayed retinal nerve fiber layer and nasal hemimacular ganglion cell layer thinning on optical coherence tomography, consistent with chiasmal pathology. Magnetic resonance imaging showed no definitive lesions at the optic chiasm or more posteriorly along the afferent visual pathway. Conclusions and importance: This patient's severe vision loss suggests that proptosis from thyroid orbitopathy can sensitize the anterior visual pathway to trauma. In this case, we propose that the lack of laxity in the intra-orbital optic nerves allowed transmission of stretching forces to the optic chiasm in the setting of low-velocity blunt trauma.

We report a case of isolated bitemporal hemianopia in traumatic chiasmal syndrome. A 20-year-old male motorcyclist was brought unconscious into the emergency department after an alleged accident involving a horse-drawn vehicle. He was intubated for three days. Computed topography of the brain revealed bifrontal and facial bone fractures, associated with subarachnoid haemorrhage. He underwent frontal bone and facial bone reconstruction. Three weeks later, patient complained of left eye blurred vision. On examination, the visual acuity was 6/7.5 in the right eye and 6/12 in the left eye, with a left relative afferent pupillary defect. Visual field charting showed complete bitemporal hemianopia. Over the next six months, the visual acuity of the left eye worsened to 6/45, while the field defect remained static. Bitemporal hemianopia in traumatic chiasmal syndrome is a rare complication of severe head injury. A history of trauma should always be elucidated in patients with visual field defects. [ABSTRACT FROM AUTHOR]

Purpose: To report a case presenting with bitemporal hemianopia due to traumatic chiasmal syndrome after head injury, and to compare the findings with individual case reports published in the literature. Methods: A detailed search was made in PubMed, MedIND, Taylor and Francis online and Wiley online library databases for individual case reports of traumatic chiasmal syndrome. All the case reports were read in full and the findings summarized in a table, which included details of the case who presented with bitemporal hemianopia as an index case. Results: All published cases of traumatic chiasmal syndrome appear to share some common features, such as injury to the frontal bone and fracture of the anterior skull base. Bitemporal hemianopia and visual acuity have a variable presentation, and do not appear to correlate with severity of injury. Isolated bitemporal hemianopia is rare and clinical improvement may or may not occur. Conclusions and importance: Traumatic chiasmal syndrome should be considered as a differential diagnosis in patients presenting with bitemporal hemianopia after head injury causing frontal and anterior skull base fracture.

We report a 26-year-old man who developed cerebrospinal fluid (CSF) rhinorrhoea and complete bitemporal hemianopia after having sustained a blunt frontal region trauma. The chronology of midline frontal trauma and CSF rhinorrhoea, followed days later by transient diabetes insipidus and discovery of a bitemporal visual field loss, makes up a unique syndrome and must be evaluated for. Mechanism of such injuries, their pertinent complications, and review of literature are herein discussed. [ABSTRACT FROM PUBLISHER]

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