Question 4: This is another patient with a compressive tumour. Please suggest the location of the tumour which would cause this visual field defect and describe the Visual fields.

Question 4: This is another patient with a compressive tumour. Please suggest the location of the tumour which would cause this visual field defect and describe the Visual fields.

The Vision is Right eye: 6/60 Left eye 6/6.

Figure 5: Visual fields in a patient with a compressive lesion

Answer 4

The visual field test was reliably performed. The visual field presented above demonstrates a dense bitemporal hemianopia. There is greater global reduction in visual field in the right eye compared to the left (the nasal hemifield is also affected in the right eye, as opposed to the temporal hemifield only in the left eye) suggesting  that the lesion is compressing the right optic nerve to a greater extent than the left.

If the tumour were at the junction of the right optic nerve and chiasm it would cause this pattern of visual field loss known as a junctional scotoma. The most common cause of a junctional scotoma is a pituitary adenoma, but other intracranial masses, including sphenoid wing meningioma, craniopharyngioma and aneurysm of the internal carotid or anterior communicating artery can also cause this type of visual field defect.

End of answer 4