Differential Diagnosis for Visual Field Defect
Single Most Likely Diagnosis
- Binasal Hemianopia: This condition occurs when there is a defect in the visual field of both eyes, specifically in the nasal quadrants. It is often associated with lesions affecting the optic chiasm, such as pituitary tumors or other sellar region masses. The presentation of a superior nasal quadrant defect in the right eye and a superotemporal quadrant defect in the left eye could be consistent with a binasal hemianopia, especially if the defects are congruous and respect the vertical meridian.
Other Likely Diagnoses
- Chiasmal Syndrome: Lesions affecting the optic chiasm, such as pituitary adenomas, craniopharyngiomas, or meningiomas, can cause a variety of visual field defects, including bitemporal hemianopia, binasal hemianopia, or a combination of defects. The specific pattern of defects can vary depending on the location and size of the lesion.
- Bitemporal Hemianopia: Although the described defects do not perfectly match a classic bitemporal hemianopia, a lesion affecting the optic chiasm could potentially cause asymmetric or incomplete field defects that might resemble the described pattern.
- Optic Nerve Lesions: Separate lesions affecting each optic nerve could result in the described visual field defects. For example, a right optic nerve lesion could cause a superior nasal quadrant defect, and a left optic nerve lesion could cause a superotemporal quadrant defect.
Do Not Miss Diagnoses
- Pituitary Apoplexy: A sudden hemorrhage or infarction of a pituitary tumor can cause acute visual disturbances, including visual field defects, and is a medical emergency. Although the described defects might not be the most common presentation, any new visual field defect warrants consideration of pituitary apoplexy.
- Meningioma: Meningiomas are tumors arising from the meninges that can compress adjacent neural structures, including the optic nerves and chiasm. They can cause a variety of visual field defects and are important to diagnose due to their potential for significant morbidity if left untreated.
Rare Diagnoses
- Traumatic Chiasmal Syndrome: Trauma can cause a chiasmal syndrome with resulting visual field defects, although this would typically be associated with a history of significant head injury.
- Inflammatory or Demyelinating Diseases: Conditions like multiple sclerosis, neuromyelitis optica, or other inflammatory diseases can affect the optic nerves and chiasm, leading to visual field defects. However, these conditions often present with additional symptoms and signs beyond isolated visual field defects.
- Arteritic or Non-Arteritic Anterior Ischemic Optic Neuropathy: These conditions can cause sudden visual loss and visual field defects, typically in one eye, but could potentially cause bilateral defects if both eyes are affected at different times or to different extents.