Shawaz Baluch - Optic nerve injury (Pakistan) Posted on October 26, 2012

Name: Shawaz Baluch   
Sex: Male
Country: Pakistan
Age: 33
Diagnoses: 1. Optic nerve injury 2. Postoperation of pituitary tumor  3. Secondary Adrenal insufficiency 4. Secondary hypothyroidism 5. hyperhomocysteinemia 6. Fatty liver (mild-moderate)
Admission Date: September 3, 2012
Days Admitted to Hospital: 29

Before treatment:
The patient suffered from slight vision blurring for more than 4 years. The MRI examination showed he had a pituitary tumor. The size of the pituitary tumor was 2.6*2.3*2.0cm. After the transsphenoidal surgery and cutting off part of the tumor, the patient's vision was restored completely. 4 months later, the patient suffered from blurred vision again. A new MRI showed the size of the pituitary tumor was 2.6*2.2*2.2cm. 1 month later, the patient received transsphenoidal surgery again. The vision was restored again. The MRI showed the size of the pituitary tumor was 0.7*1.5cm. Normal vision was sustained for 5 months. About 3 years ago, the patient's vision was reduced again. They only had central visual field. The MRI showed that the pituitary tumor was enlarged. The patient received radio therapy, but the pituitary tumor was still growing. The vision went down continuly. The patient received a craniotomy 1 year ago. The pituitary tumor was cut off completely. The vision showed no improvement after the operation. At present, the patient's left eye has light sensation at the distance of 3-4cm ahead. Right central vision field can see the shadow of an object. The diameter of the left eyeball was 3cm. The diameter of the right eyeball was 3cm. Both eyes presented tubular vision. Other vision and visual field had afunction. There was no color vision.

Nervous System Examination:
Shawaz Baluch was alert. The memory, orientation and calculation abilities were almost normal. The diameter of both pupils was 4.0mms. Both pupils had no responses to direct and indirect light stimulus. Straight ahead the left eye at 3-4cm distance had light sensation. The left eye had tubular visual field. The right eye had tubular visual field, too. It could only see the object's shadow from 3 meters distance. Right upper quadrant had dot scope dark shadow. And it could only distinguish the color blue. Both eyeballs could move flexibly, with no obvious nystagmus. The optic papilla was not clear. Ophthalmoscope: the eye fundus the arteriovenous ratio was 1:3, and appeared as a light yellow. The vessels were slim. The forehead wrinkle pattern was symmetrical. The bilateral nasolabial sulcus was equal in depth. The tongue was centered in the oral cavity and the teeth were shown without deflection. The neck had flexible movement. The muscle tone of the four limbs was almost normal. The muscle strength of the four limbs was almost normal. The tendon reflex of the four limbs was elicited normally. The abdominal reflexes were not elicited. The sucking reflex and palm jaw reflex were negative. Bilateral Hoffmann sign was negative. Bilateral Rossolimo sign was negative. Bilateral Babinski sign was negative. He had normal deep and shallow sensation. The coordinate movement examination was normal. The meningeal irritation was negative. Before the admission: Cortisol 2012-8-27: <28nmol/L(138-690 nmol/L), growth hormone 2012-8-27: 0.2mIU/ml (1.2-8.6 mIU/ml); follicular stimulating hormone 2012-8-27:0.6 mIU/ml(1.3-19.3 mIU/ml). Ephippium MRI2011-3-5: post-operation of hypophysoma complete resection, optic chiasma was not obvious, intracranial structures showed no abnormalities. Ephippium MRI 2011-7-24: change after hypophysoma resection, atrophy of optic chiasma.

Treatment:
We gave Shawaz Baluch a complete examination. He received treatment to improve the blood circulation in order to increase the blood supply to the damaged nerves. He was also given treatment to nourish the neurons, boost immunity and nerve regeneration.

Post-treatment:
Bilateral pupils have direct reflection and indirect reflection to light stimulus. And the right side is more flexible than the left side. Left eye has light sensation in front of 50 cm distance. Under natural light, his left eye can see the object's shadow from 2cm. And the visual field of the left eye is almost normal. The dotted dark shadow is reduced 40% in the right eye. He can see objects more clearly than before. And the visual field of the right eye is better than before, the under visual field of right eye is almost normal. Examination with an ophthalmoscope showed: Left fundus' center appears light yellow. Left eye's periphery and most of right fundus appears orange. The vessels are clearer. Right optic papilla is clearer and the definition increased 20%.