Visual disturbances associated with primary empty sella syndrome

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The term empty sella was introduced by Busch1 in 1951 to describe autopsy findings in which the diaphragma sella was incompetent or formed only a peripheral rim of tissue with the pituitary gland compressed at the bottom of the sella turcica. The term empty sella syndrome was introduced by Colby and Kearns2 in 1962 to refer to symptoms of progressive visual impairment in a patient after irradiation for an intrasellar tumor despite lack of tumor recurrence. At operation, the optic nerves and chiasm were seen to be drawn into the sella by adhesions. Three similar cases were described by Lee and Adams3 who also applied the term empty sella syndrome to them. Weiss and Raskind4 distinguished primary from secondary empty sella.

Primary empty sella refers to a sella that (a) may or may not be enlarged, (b) admits air on pneumoencephalography or appears empty at surgery, and (c) there has been no operation or irradiation previously for pituitary tumor.

Visual disturbances such as decreased acuity and blurred vision have been described in primary empty sella.5 Visual field defects, although considered rare, have also been described.5–7 However, severe visual disturbances have not been reported in primary empty sella. The following is a case report of a patient with primary empty sella, severe visual deficits, and bilateral optic atrophy.

Case report

A 53-year-old black man was admitted to the Cleveland Clinic Hospital with a 3½-year history of blurred vision and progressively decreasing visual acuity in both eyes. At a previous examination bilateral optic . . .



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