Junctional Visual Field Loss in a Case of Wyburn-Mason Syndrome

The varieties of junctional scotoma: 17 cases, a review, and a taxonomy

The hemi-decussation at the optic chiasm creates the potential for crossed and uncrossed fibers to be affected in isolation or in various combinations of nerve, chiasm and tract, with patterns that reflect the retinotopic arrangement of axons. We present seventeen cases that illustrate the field defects that can result and review the literature to create a taxonomy of junctional visual field defects. The complete junction defect is blindness in one eye and loss of the entire temporal field of the other. The classic junctional scotoma combines optic neuropathy in one eye with upper temporal hemifield loss in the other, and is often a sign of ventral compression. The less frequent atypical junctional scotoma involves the lower temporal hemifield and has a higher frequency of dorsal compression or non-compressive pathology. There are the monocular defects in the temporal ('junctional scotoma of Traquair') or nasal hemifield, the latter of which is rarely if ever due to a pituitary adenoma. Highly asymmetric bitemporal defects with or without a central scotoma and the paradoxical junctional scotoma occur by extension of the lesion causing the junctional scotoma of Traquair. The posterior junction defect results from combined damage to the optic chiasm and optic tract. Recognizing these various patterns is important clinically as junctional defects have the same localizing significance as bitemporal defects and are being encountered more often. In addition the probability of certain types of pathology varies with the type of junctional defect.

Wyburn-Mason Syndrome: A Narrative Review

Wyburn-Mason syndrome is a rare congenital disorder characterized by arteriovenous malformations (AVMs) in the retina, brain, and occasionally the skin. The syndrome results from embryonic vascular abnormalities and presents with a wide spectrum of clinical manifestations, classified into three groups based on severity. Diagnosis relies heavily on imaging techniques, with optical coherence tomography (OCT) and cerebral angiography playing crucial roles. Management is typically conservative due to the stability of most AVMs, but intervention may be necessary when the rupture risk of intracranial AVMs exceeds 2.2% per year. Treatment options include endovascular embolization, surgical resection, and emerging therapies like intravitreal injections. This review emphasizes the importance of a multidisciplinary approach involving ophthalmologists, neurologists, and interventional radiologists, as well as regular monitoring of asymptomatic AVMs to optimize patient outcomes and quality of life.

Metastatic paraganglioma presenting as ajunctional scotoma

PURPOSE

To report a unique case of metastatic paraganglioma presenting as a junctional scotoma.

OBSERVATIONS

A 38-year-old Caucasian man with a history of abdominal paraganglioma presented with minimally blurred vision 20/25 visual acuity in the left eye. The patient was found to have a junctional scotoma upon visual field testing. Cranial MRI revealed a large peri-clival mass compressing the pre-chiasmal optic nerves and other loci of metastatic disease. Intracranial masses, including metastases, can present with a relatively intact central acuity and nonspecific visual symptoms.

CONCLUSIONS AND IMPORTANCE

To the best of our knowledge, this is the first report of metastatic paraganglioma causing a junctional scotoma. In cases with junctional scotoma, careful neuro-ophthalmic assessment and imaging are of paramount importance, even in patients with excellent visual acuity.

Retinal manifestations of the neurocutaneous disorders

PURPOSE OF REVIEW

The neurocutaneous disorders are a genetically and phenotypically diverse group of congenital syndromes characterized by cutaneous, ocular, and central nervous system manifestations. This review provides an overview of the clinical features and retinal findings in selected neurocutaneous disorders.

RECENT FINDINGS

Advances in genetics and diagnostic retinal and neuroimaging allow for the recognition of retinal features of common neurocutaneous syndromes and for improved characterization of rarer entities based on previously underdiagnosed or unrecognized retinal findings.

SUMMARY

Better characterization of the neurocutaneous disorders allows for earlier recognition and the potential for expeditious vision-saving and life-saving treatment.