To the Editor.—
The article by Drs Sacks and Melen (234:69, 1975) was enlightening in view of the rare occurrence of simultaneous bitemporal field defects in multiple sclerosis; however, the implications of ascribing this type of field loss to only a presumed diagnosis of multiple sclerosis in a patient so affected may be misleading and should be cautioned against.Multiple sclerosis does not protect the nervous system from other insults. Slow-growing meningiomas, parasellar cysts, intrasellar and extrasellar tumors, or aneurysmal dilation of the supraclinoid portion of the carotid artery have all been associated with the chiasmal syndrome thereby resulting in subtle, unrecognized visual field loss. Granted that lesion spread in time and space in the nervous system suggests multiple sclerosis, one could become concerned about attributing the sudden development of bitemporal visual field loss to multiple sclerosis alone. Certainly, with the knowledge gained from noninvasive neuroradiological procedures such as sodium
Lavenstein B. Bitemporal Visual Field Loss in Presumed Multiple Sclerosis. JAMA. 1976;235(8):804. doi:10.1001/jama.1976.03260340014007
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