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April 11, 1986

Empty Sella Syndrome Caused by Syphilitic Arachnoiditis

Author Affiliations

Duke University Medical Center Durham, NC

JAMA. 1986;255(14):1882. doi:10.1001/jama.1986.03370140080026

To the Editor.—  The empty sella syndrome has been the subject of extensive review.1,2 This syndrome may occur spontaneously or be secondary to one of several intrasellar or extrasellar disease processes. I describe a hitherto unreported association of the empty sella syndrome occurring in the presence of active syphilitic arachnoiditis localized to the optic chiasm and diaphragma sellae.

Report of a Case.—  A 47-year-old man was admitted to the hospital for evaluation of progressive visual loss. The onset of visual loss was sudden and painless, occurring over a 24-hour period. His vision gradually deteriorated over the next four months. He had been well all his life and he denied any recent headaches or change in libido. He had no history of head trauma, head irradiation, endocrine dysfunction, venereal disease, or methanol abuse. Details of his family history revealed no previous ophthalmologic problems.Physical examination showed bilateral optic atrophy with