Skip to main content

Non-Compressive Disorders of the Chiasm

Current Neurology and Neuroscience Reports volume 14, Article number: 455 (2014) Cite this article

Abstract

Chiasmal dysfunction produces a characteristic clinical picture, regardless of the mechanism. In most cases a compressive lesion is the cause. In occasional cases, however, no such extrinsic mass is found and other possible etiologies must be explored. In some of these cases, the pathologic process is identifiable with appropriate neuroimaging. For example, inflammation, infiltrative tumors, and radiation necrosis produce intrinsic chiasmal enhancement. Chiasmal ischemia may require specialized magnetic resonance (MR) sequences for diagnosis. Chiasmal hemorrhage, trauma and chiasmal herniation typically produce distinctive changes on noncontrasted imaging. In cases of metabolic insult, either toxic or hereditary, radiographic changes are typically absent. In each of these, the correct diagnosis can usually be made with a combination of clinical and radiographic features.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Pula JH, Fischer M, Kattah JC. Hemifield slide from traumatic optic chiasmopathy. J Clin Neurosci. 2014. doi:10.1016/j.jocn.2014.01.001.

    PubMed  Google Scholar 

  2. Van Waveren M, Jägle H, Besch D. Management of strabismus with hemianopic visual field defects. Graefes Arch Clin Exp Ophthalmol. 2013;251:575–84.

    PubMed  Article  Google Scholar 

  3. Weber KP, Landau K. Mind the gap! Postfixational blindness due to traumatic rupture of the optic chiasm. Neurology. 2013;80:e197–8.

    PubMed  Article  Google Scholar 

  4. Kawasaki A, Purvin VA. Idiopathic chiasmal neuritis: clinical features and prognosis. Arch Ophthalmol. 2009;127:76–81.

    PubMed  Article  Google Scholar 

  5. Lee S-Y, Wang A-G, Yen M-Y. Chiasmal optic neuritis: a report of 3 cases. Taiwan J Ophthalmol. 2012;2:68–72.

    Article  Google Scholar 

  6. Purvin V, Herr GJ, DeMyer W. Chiasmal neuritis as a complication of Epstein-Barr virus infection. Arch Neurol. 1988;45:458–60.

    CAS  PubMed  Article  Google Scholar 

  7. Scott IU, Silva-Lepe A, Siatkowski RM. Chiasmal optic neuritis in Lyme disease. Am J Ophthalmol. 1997;123:136–8.

    CAS  PubMed  Article  Google Scholar 

  8. Irioka T, Akaza M, Nakao K, et al. Chiasmal optic neuritis following mumps parotitis. J Neurol. 2008;255:773–4.

    PubMed  Article  Google Scholar 

  9. Frohman LP, Frieman BJ, Wolansky L. Reversible blindness resulting from optic chiasmitis secondary to systemic lupus erythematosus. J Neuroophthalmol. 2001;21:18–21.

    CAS  PubMed  Article  Google Scholar 

  10. Greven CM, Singh T, Stanton CA, et al. Optic chiasm, optic nerve, and retinal involvement secondary to varicella-zoster virus. Arch Ophthalmol. 2001;21:18–21.

    Google Scholar 

  11. Tang RA, Grotta JC, Lee KF, et al. Chiasmal syndrome in sarcoidosis. Arch Ophthalmol. 1983;101:1069–73.

    CAS  PubMed  Article  Google Scholar 

  12. Hervey-Jumper SL, Ghori A, Ziewacz JE, et al. Langerhans cell histiocytosis of the optic chiasm: case report. Neurosurgery. 2011;68:E556–61.

    PubMed  Article  Google Scholar 

  13. DiMario Jr FJ, Hajjar M, Ciesielski T. A 16-year-old girl with bilateral visual loss and left hemiparesis following immunization against Human Papilloma Virus. J Child Neurol. 2010;25:773–4.

    Article  Google Scholar 

  14. Costa RM, Santos AC, Costa S. An unusual chiasmal visual defect in a patient with neuromyelitis optica: case report. Arq Bras Oftalmol. 2007;70:153–5.

    PubMed  Article  Google Scholar 

  15. Calawaerts E, De Waele L, Buyse G, et al. Chiasmal optic neuritis in a 4-year-old girl. Bull Soc Belge Ophthalmol. 2012;320:5–10. While chiasmal optic neuritis typically affects young adults, children are occasionally affected, as evidenced by this report.

    Google Scholar 

  16. Garg RK, Paliwal V, Malhotra HS. Tuberculous optochiasmatic arachnoiditis: a devastating form of tuberculous meningitis. Expert Rev Antiinfective Ther. 2011;9:719–29.

    Article  Google Scholar 

  17. Joseph M, Mendonca TM, Vasu U, et al. Paradoxical growth of presumed optochiasmatic tuberculomas following medical therapy. JAMA Ophthalmol. 2013;131:1463–7.

    PubMed  Article  Google Scholar 

  18. Weinstein GW, Powell SR, Thrush WP. Chiasmal neuropathy secondary to rheumatoid pachymeningitis. Am J Ophthalmol. 1987;104:439–40.

    CAS  PubMed  Article  Google Scholar 

  19. Hughes J, Barkhoudarian G, Ciarlini P, et al. Refractory pituitary granulomatosis with polyangiitis (Wegener’s) treated with rituximab. Endocr Pract. 2013;19:e1–7.

    PubMed  Article  Google Scholar 

  20. Leung GKK, Lopes M-B S, Thorner MO, et al. Primary hypophysitis: a single-center experience in 16 cases. J Neurosurg. 2011;15:262–71.

    Google Scholar 

  21. Quigley EP, Osborn A. Advanced imaging of anterior visual pathway ischemia: state of the art and future directions. J Neuroophthalmol. 2010;30:213–5.

    PubMed  Article  Google Scholar 

  22. Oku H, Matsuo J, Etomi T, et al. Acute infarction at the opto-chiasmal junction detected by diffusion weighted magnetic resonance imaging. J Neuroophthalmol. 2009;33:257–60.

    Article  Google Scholar 

  23. Fabian ID, Greenberg G, Huna-Baron R. Chiasmal stroke following open-heart surgery. J Neuroophthalmol. 2010;30:219–21.

    PubMed  Article  Google Scholar 

  24. Shelton JB, Digre KB, Katz BJ, et al. Chiasmal stroke in patient with atrial fibrillation and complete occlusion of right internal carotid artery. J Neuroophthalmol. 2012;32:189. This report documents clinical and imaging findings in this rare case of embolic stroke involving the chiasm.

    PubMed  Article  Google Scholar 

  25. Johnson JN, Elhammady M, Post J, et al. Optic pathway infarct after Onyx HD aneurysm embolization: visual pathway ischemia from superior hypophyseal artery occlusion. BMJ Case Rep. 2013. doi:10.1136/bcr-2013-010968.

    Google Scholar 

  26. Liu JK, Lu Y, Raslan AM, et al. Cavernous malformation of the optic pathway and hypothalamus: analysis of 65 cases in the literature. Neurosurg Focus. 2010;29:E17.

    PubMed  Article  Google Scholar 

  27. Ball BG, Wetmore C, Giannini C, et al. Opticochiasmatic apoplexy in a five-year-old. Pediatr Neurosurg. 2011;47:279–83.

    PubMed  Article  Google Scholar 

  28. Avery RA, Fisher MJ, Liu GT. Optic pathway gliomas. J Neuroophthalmol. 2011;31:269–78.

    PubMed  Article  Google Scholar 

  29. Shapey J, Danesh-Meyer HV, Kaye AH. Diagnosis and management of optic nerve glioma. J Clin Neurosci. 2011;18:1585–91.

    CAS  PubMed  Article  Google Scholar 

  30. Matloob S, Fan JC, Danesh-Meyer HV. Multifocal malignant optic glioma of adulthood presenting as an acute anterior optic neuropathy. J Clin Neurosci. 2011;18:974–7.

    PubMed  Article  Google Scholar 

  31. Dinh TT, Wang YY, Rosenfeld JV, et al. Glioblastoma of the optic chiasm. J Clin Neurosci. 2007;14:502–5.

    CAS  PubMed  Article  Google Scholar 

  32. Liu Y, Zhang-Nunes S, Zhu X, et al. Late adult onset optic pathway astrocytoma. J Clin Neurosci. 2013;20:1610–2.

    PubMed  Article  Google Scholar 

  33. Traynis I, Singer S, Winterkorn J, et al. Infiltration of the optic chiasm, nerve, and disc by gliomatosis cerebri. J Neuroophthalmol. 2014;34:44–6.

    PubMed  Article  Google Scholar 

  34. Peretti-Viton P, Brunel H, Chinot O, et al. Histological and MR correlations in gliomatosis cerebri. J Neurooncol. 2002;59:249–59.

    PubMed  Article  Google Scholar 

  35. Listernick R, Ferner RE, Liu GT, et al. Optic pathway gliomas in neurofibromatosis-1: controversies and recommendations. Ann Neurol. 2007;61:189–98.

    CAS  PubMed  Article  Google Scholar 

  36. Spicer GJ, Kazim M, Glass LRD, et al. Accuracy of MRI in defining tumor-free margin in optic nerve glioma surgery. Ophthal Plast Reconstr Surg. 2013;29:277–80. Expanding on previous anecdotal reports, this study quantifies the accuracy of MRI for predicting posterior extension of optic nerve glioma.

    PubMed  Article  Google Scholar 

  37. Lober RM, Guzman R, Chesier SH, et al. Application of diffusion tensor tractography in pediatric optic pathway glioma. J Neurosurg. 2012;10:273–80.

    Google Scholar 

  38. Tsutsumi K, Horiuchi T, Aoyama T, et al. Isolated primary malignant lymphoma arising from the optic chiasm. J Clin Neurosci. 2013;20:1783–6.

    PubMed  Article  Google Scholar 

  39. Baraniskin A, Deckert M, Schulte-Altedorneburg, et al. Current strategies in the diagnosis of diffuse large B-cell lymphoma of the central nervous system. Br J Haematol. 2012. doi:10.1111/j.1365-2141.2011.

    PubMed  Google Scholar 

  40. Zelefsky JR, Revercomb CH, Lantos G, et al. Isolated lymphoma of the anterior visual pathway by optic nerve biopsy. J Neuroophthalmol. 2008;28:36–40.

    PubMed  Article  Google Scholar 

  41. Xia C, Liu Z, Zhang R, et al. Primary intrinsic optic chiasm germinoma. J Clin Neurosci. 2011;18:860–2.

    PubMed  Article  Google Scholar 

  42. Mataftsi A, Zografos L, Balmer A, et al. Chiasmatic infiltration secondary to late malignant transformation of retinoma. Ophthalmic Genet. 2012;33:155–8.

    PubMed  Article  Google Scholar 

  43. Menon V, Jain D, Saxena R, et al. Prospective evaluation of visual function for early detection of ethambutol toxicity. Br J Ophthalmol. 2009;93:1251–4.

    CAS  PubMed  Article  Google Scholar 

  44. Fraunfelder FW, Sadun AA. Update on ethambutol optic neuropathy. Expert Opin Drug Saf. 2006;5:615–8.

    CAS  PubMed  Article  Google Scholar 

  45. Kinoshita J, Iwata N, Maejima T, et al. Retinal function and morphology in monkeys with ethambutol-induced optic neuropathy. Invest Ophthalmol Vis Sci. 2012;53:7052–62. Histopathologic study has demonstrated retinal ganglion cells, particularly in the nasal area, are selectively damaged due to ethambutol. Demyelination and gliosis occurs in the optic nerves, chiasm, and optic tracts.

    PubMed  Article  Google Scholar 

  46. Boulanger Scemama E, Touitou V, Le Hoang P. Bitemporal hemianopsia as presenting sign of severe ethambutol toxicity. J Fr Ophtalmol. 2013;36:e163–7.

    CAS  PubMed  Article  Google Scholar 

  47. Osaquona VB, Sharpe JA, Awaji SA, et al. Optic chiasm involvement on MRI with ethambutol-induced bitemporal hemianopia. J Neuroophthalmol. 2014.

  48. Danesh-Meyer HV. Radiation-induced optic neuropathy. J Clin Neurosci. 2008;15:95–100.

    PubMed  Article  Google Scholar 

  49. Lee MS, Borruat FX. Should patients with radiation-induced optic neuropathy receive any treatment? J Neuroophthalmol. 2011;31:83–8. This paper gives point-counterpoint arguments for using hyperbaric oxygen in patients with visual loss due to radiation optic neuropathy.

    PubMed  Article  Google Scholar 

  50. Hepgül G, Tanrikulu S, Unalp HR, et al. Preventive effect of pentoxifylline on acute radiation damage via antioxidant and anti-inflammatory pathways. Dig Dis Sci. 2010;55:617–25.

    PubMed  Article  Google Scholar 

  51. Farooq O, Lincoff NS, Saikali N, et al. Novel treatment for radiation optic neuropathy with intravenous bevacizumab. J Neuroophthalmol. 2012;32:321–4.

    PubMed  Article  Google Scholar 

  52. Finger PT. Anti-VEGF bevacizumab (Avastin) for radiation optic neuropathy. Am J Ophthalmol. 2007;143:335–8.

    CAS  PubMed  Article  Google Scholar 

  53. Hassan A, Crompton JL, Sandhu A. Traumatic chiasmal syndrome: a series of 19 patients. Clin Exp Ophthalmol. 2002;30:263–80.

    Article  Google Scholar 

  54. Mohindra S, Sharma M, Monindra S. Traumatic chiasmal syndrome. Br J Neurosurg. 2012;2:872–4.

    Article  Google Scholar 

  55. Heinz GW, Nunery WR, Grossman CB. Traumatic chiasmal syndrome associated with midline basilar skull fractures. Am J Ophthalmol. 1994;117:90–6.

    CAS  PubMed  Article  Google Scholar 

  56. Segal L, An JA, Gans M. Traumatic disruption of the optic chiasm. J Neuroophthalmol. 2009;29:308–10.

    PubMed  Article  Google Scholar 

  57. Atipo-Tsiba PW, Borruat FX. Traumatic dysfunction of the optic chiasm. Klin Monbl Augenheilkd. 2003;220:138–41.

    PubMed  Article  Google Scholar 

  58. Prasad S, Golby A. Chiasmal visual loss after retinal detachment. Neurology. 2012;78:149.

    Google Scholar 

  59. Dorotheo EU, Tang RA, Bahrani HM, et al. Her vision was tied down. Surv Ophthalmol. 2005;50:588–97.

    PubMed  Article  Google Scholar 

  60. Griffiths PG, Dayan M, Coulthard A. Primary empty sella: cause of visual failure or chance association? Eye. 1998;12:905–6.

    PubMed  Article  Google Scholar 

  61. Jones SE, James RA, Hall K, Kendall-Taylor P. Optic chiasmal herniation-an under recognized complication of dopamine agonist therapy for macroprolactinoma. Clin Endocrinol. 2000;53:529–34.

    CAS  Article  Google Scholar 

  62. Dhanwal DK, Sharma AK. Brain and optic chiasmal herniations into sella after cabergoline therapy of giant prolactinoma. Pituitary. 2011;14:383–7.

    Article  Google Scholar 

  63. Chuman H, Cornblath WT, Trobe JD, et al. Delayed visual loss following pergolide treatment of a prolactinoma. J Neuroophthalmol. 2002;22:102–6.

    PubMed  Article  Google Scholar 

  64. Nomikos P, Buchfelder M, Fahlbusch R. Current management of prolactinomas. J Neurooncol. 2001;54:139–50.

    CAS  PubMed  Article  Google Scholar 

  65. Gkekas N, Primikiris P, Georgakoulias N. Untethering of herniated left optic nerve after dopamine agonist treatment for giant prolactinoma. Acta Neurochir. 2013;155:495–6.

    PubMed  Article  Google Scholar 

  66. Hamlyn PJ, Baer R, Afshar F. Transsphenoidal chiasmopexy for long standing visual failure in the secondary empty sella syndrome. Br J Neurosurg. 1988;2:277–9.

    CAS  PubMed  Article  Google Scholar 

  67. Zona G, Testa V, Sbaffi PF, et al. Transsphenoidal treatment of empty sella by means of a silastic coil: technical note. Neurosurgery. 2002;51:1299–303.

    PubMed  Article  Google Scholar 

  68. Riordan-Eva P, Sanders MD, Govan GG, et al. The clinical features of Leber’s hereditary optic neuropathy defined by the presence of a pathogenic mitochondrial DNA mutation. Brain. 1995;118:319–37.

    PubMed  Article  Google Scholar 

  69. Phillips PH, Vaphiades M, Glasier CM, et al. Chiasmal enlargement and optic nerve enhancement on magnetic resonance imaging in Leber hereditary optic neuropathy. Arch Ophthalmol. 2003;121:577–8.

    PubMed  Article  Google Scholar 

  70. Ong E, Biotti D, Abouaf L, et al. Chiasmal enlargement and enhancement in Leber hereditary optic neuropathy. Neurology. 2013;81:e126–7.

    PubMed  Article  Google Scholar 

  71. Van Western D, Hammar B, Bynke G. Magnetic resonance findings in the pregeniculate visual pathways in Leber hereditary optic neuropathy. J Neuroophthalmol. 2011;31:48–51. This is a photo essay paper that demonstrates the subacute and chronic changes along the afferent visual pathway (from retrobulbar optic nerve to optic tracts) that can occur in patients with LHON.

    Article  Google Scholar 

  72. Batioglu F, Atilla H, Eryilmaz T. Chiasmal high signal on magnetic resonance imaging in the atrophic phase of Leber hereditary optic neuropathy. J Neuroophthalmol. 2003;23:28–30.

    PubMed  Article  Google Scholar 

Download references

Compliance with Ethics Guidelines

ᅟ

Conflict of Interest

Valerie A. Purvin has received book royalties from Cambridge University Press. Aki Kawasaki has received a research grant from Egalité; University of Lausanne, honoraria from Springer for editorial service, and book royalties from Cambridge University Press.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Affiliations

  1. Department of Ophthalmology, Indiana University Medical Center, Indianapolis, IN, USA

    Valerie A. Purvin

  2. Glick Eye Institute and Ophthalmology Center, 1160 West Michigan Street, Indianapolis, IN, 46202, USA

    Valerie A. Purvin

  3. Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland

    Aki Kawasaki

  4. Hôpital Ophtalmique Jules Gonin, Avenue de France 15, Lausanne, Switzerland, 1004

    Aki Kawasaki

Authors
  1. Valerie A. Purvin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aki Kawasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aki Kawasaki.

Additional information

This article is part of the Topical Collection on Neuro-Ophthalmology

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Purvin, V.A., Kawasaki, A. Non-Compressive Disorders of the Chiasm. Curr Neurol Neurosci Rep 14, 455 (2014). https://doi.org/10.1007/s11910-014-0455-7

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11910-014-0455-7

Keywords

  • Optic chiasm
  • Chiasm
  • Optic nerve
  • Chiasmitis
  • Bitemporal visual field defect
  • Demyelination
  • Chiasmal glioma
  • Chiasmal trauma
  • Ethambutol toxicity
  • Radiation optic neuropathy