42 Bitemporal hemianopia
Salient features
Examination
• Bitemporal hemianopia, which is caused by a median lesion of the optic chiasma (see Fig. 41.1).
• Proceed by examining the hands and face for acromegaly.
• Tell the examiner that you would like to look for signs of hypopituitarism (p. 534). The probable causes are:
• pituitary tumour (endocrine symptoms precede the visual symptoms; the upper temporal fields affected first and then defect spreads down)
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