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What is a prefixed, normal, postfixed chiasm?
- prefixed: chiasm is BEFORE pituitary gland-15%- OT first
- normal: 80%- chiasm first
- postfixed: chiasm is AFTER pituitary gland- 5%- ON first
Signs and symptoms of chiasmal lesions?
- vision loss
- VF BITEMPORAL HEMIANOPIA- vert midline
- ON: bowtie
- high levels of cortisol- pituitary adenoma
- moonface, cns, hirutism, hypertension, diabetes
- obesity, skin striae, bruising, muscle weakness, osteoperosis, ankle edema
- pituitary adenoma- excess growth hormone
- facial coarseness, organomegaly, enlarged jaw
- hypertension, diabetes, arthritis
- carpal tunnel, cardiomyopathy
- autoimmune, TED, hyperthyroidism-
- Caused by autoantibodies binding to and stimulating TSH-R=more T3 and T4
- F, 30-40
Signs of Graves?
- rapid heartbeat
- muscular weakness
- enlarged thryoid gland
- seen in Grave's
- proptosis, enlarged EOM, corneal exposure, lid retraction and lag
- ON compression: decreased CV, slow VA, central scotoma, optic atrophy
- tx: steroids, smoking, lubricants, botox
- loss of nasal and papillomacular RNFL= bowtie atrophy
- sup/inf OD ok
tumour pressing on anterior chiasm?
- nasal: temporal VF
- inferior: superior VF
Tumour pressing on superior chiasm?
- nasal: bitemporal hemianopia VF
- superior: affects more inferior
Tuberculum sellae meningioma
- older menopausal women
- junctional scotoma
- disorder of face perception/recognition
- Lesions occur in: fusiform gyrus, occipital lobe or temporal cortex
- mainly in the right hemisphere: plays greater role in facial processing
- VF results: left homonymous hemianopia
- also achromatopsia