NOTES OF A CASE 
OF 
OPTIC ATROPHY AND TEMPORAL 
HEMIANOPSIA; SUSPECTED 
TUMOR OF THE PITU- 
ITARY BODY. 
BY 
G. E. DeSCHWEINITZ, M.D., 
PHILADELPHIA, PA. 
[REPRINTED FROM THE MEDICAL AND SURGICAL 
REPORTER FOR OCTOBER 8, 1887.J [From The Medical and Surgical Reporter, 
October 8th, 1887.] 
NOTES OF A CASE OF OPTIC ATRO- 
PHY AND TEMPORAL HEMIAN- 
OPSIA; SUSPECTED TUMOR 
OF THE PITUITARY BODY. 
BY G. E. DE SCHWEINITZ, M. D., 
Ophthalmologist to the Orthopaedic Hospital and 
Infirmary for Nervous Diseases; Ophthalmologist 
to the Philadelphia Hospital. 
I am induced to publish the notes of the 
following case on account of its similarity 
to one presented recently by Mr. Story, of 
Dublin, to the Ophthalmological Society of 
the United Kingdom. In the discussion 
which followed this presentation, references 
to other similar published cases were made, 
and in one of the instances quoted, a post 
mortem examination had revealed the pres- 
ence of a tumor of the pituitary body. 
Mary A., aged 15, presented herself for 
treatment with the following statement: As 
a child, she was subject to headaches, and 
often complained of dim vision, which would 
speedily disappear if she rested her eyes. For 
the past two years the failure of vision had 
been marked and unrelieved by any period 
or periods of improved sight. One year ago, 
while reading, the page became blank, and 
since that time reading has been impossible. i 
Examination of the Eyes.—R. E. sees 
hand move; L. E. 2£. Pupils large, 6.5 
m. m. facing window, they reacted slowly 
to the changes of light and shade ; anterior 
chambers natural; irides blue and alike in 
shade. The ophthalmoscope revealed in the 
right eye a small, oval optic nerve, entirely 
green and devoid of capillarity; out and 
below an absorbing pigment conus, and on 
the nasal side an area of choroiditis; lymph 
spaces along arteries full; hypermetropia, 
2.5°. In the left eye a small, oval optic 
nerve; nerve color green, but still partially 
capillary; vein and artery each full size; 
hypermetropia, 2D. 
The fields of vision were, as in the dia* 
grams below, quite typical temporal hemia- 
L.E. 3 
n.E. 
Fig. i.—Bitemporal hemianopsia. The outer 
tracings bound the limits of the normal fields for 
white; the inner tracings show the areas of the 
fields as they existed. 
Tiopsia. The field of the left eye was taken 
with a one centimeter square of white; that 
of the right eye with two candles, the flame 
of one of which was used for fixation, while 
that of the other was employed as the test 
object. 
The patient came of healthy Scotch-Irish 
parentage, and with the exception of whoop- 
ing cough and measles and the headaches 
before described, had had no noteworthy 
illnesses during early childhood. At birth 
three blue spots (venous naevi) were noted, 
one over the upper part of the left sterno- cleido-mastoid, one at the angle of the jaw, 
and one on the face in front of the ear. 
When the child was eight years old, the spot 
in front of the ear began to increase. At 
the time she was seen there was a purplish 
tumor, doughy and inelastic to the touch, 
extending from in front of the ear on a level 
with the zygoma, across the angle of the jaw 
and into the superior carotid triangle. The 
growth was ten centimeters in length and 
eight centimeters in breadth. The left auricle 
was of a mottled, reddish-purple color. When 
about ten years of age, this girl began to 
rapidly grow stout, so that at the time this 
examination was made, viz., in her sixteenth 
year, she presented a development unusual 
for a girl of her years. This growth had 
been symmetrical; there was no excessive 
development of the hands, feet or head; 
neither was there any deformity of the bones, 
nor indeed of any part except the presence 
of the tumor before described. Menstruation 
began in her fourteenth year, and she suf- 
fered severely from dysmenorrhoea. The 
tongue was clean, the bowels regular and 
her appetite good in spite of a very distress- 
ing nausea which often accompanied or fol- 
lowed an almost constant occipital headache. 
The urine was normal in quantity and color 
and contained no albumin nor sugar. The 
mental faculties were undisturbed, the knee- 
jerks normal and there was no anaesthesia, 
hypersesthesia, nor paraesthesia, although she 
apparently appreciated the prick of a pin 
more readily on the left than on the right 
side. Often during the day-time this patient 
4 5 
became very drowsy and slept for hours at a 
time; on awakening she was cheerful and 
lively. Her nights were usually good, al- 
though occasionally restless. Few days 
passed without these periods of drowsiness 
and sleep unless her mind was actively en- 
gaged. Excessive sweating, confined chiefly 
to the face, neck, hands and feet was a 
marked symptom. When last seen, five 
months after her original visit, no change in 
the ocular symptoms had taken place, except 
a distinct failure of sight in the left eye. 
Treatment.—This has been in the main 
very unsatisfactory, as it of necessity must 
have been, except as far as the occipital 
headaches and nausea were concerned. A 
host of sedative and depresso-motor remedies 
had been tried without success, but these 
two symptoms yielded to successive fly-blis- 
ters placed over the occiput and along the 
nape of the neck. Although deprived of 
useful sight and apparently doomed to still 
further depreciation of vision, her health in 
other respects is well-nigh perfect. 
Remarks.—The prominent symptoms of 
the case just described were optic atrophy most 
marked in the right eye; temporal hemi- 
anopsia; occipital headache, nausea and 
dysmenorrhoea; a tendency to grow stout 
and periods of drowsiness. These symptoms 
were closely analogous to those present in the 
case reported by Mr. Story (Lancet, July 25, 
1887, p. 1283). Dr. Hill Griffith and Dr. 
James Anderson referred to similar cases 
which they had seen and placed upon record. 
One symptom was present in the case which I 6 
have just detailed, provided this be an in- 
stance of tumor of the pituitary body, 
which I have not seen in other reported cases 
or supposed cases, viz.: excessive sweating, 
especially of the hands and feet. The pitui- 
tary body is composed of anterior and poste- 
rior lobes, the former of which are made up 
of a fibrous stroma, which contains numerous 
round and oval follicles filled with epithelial 
cells, while the latter are formed of a vascu- 
lar connective tissue, in which collections of 
fat granules are found. Tumor formation in 
this body, while perhaps not of very frequent 
occurrence, has still been quite often noted. 
Cysts have been described and reported by 
Zenker ( Virch. Archiv., vol. 12) and Weich- 
selbaum {Ibid., vol. 75). A true adenoma of 
this region has been observed by Weigert 
( Virch. Archiv., vol 65); Weichselbaum (loc. 
cit.'), and Ribbert {Ibid., vol. 90). Klebs 
( Viertelj. f. prakt. Heilk, 125) describes car- 
cinoma and sarcoma. Weigert {loc. cit.) has 
seen gummata and Weichselbaum {loc. cit.) 
has recorded one instance of lipoma which 
grew from the posterior lobes of the pituitary 
body. Other instances of new growth of this 
region will be found in the Transactions of the 
Ophthalmological Society of the United 
Kingdom. There is a very curious state first 
described by M. Marie (Lancet, 1886, vol. 1, 
p. 1030) and named by him acromegalie, in 
which there is an acquired hypertrophy of the 
upper and lower extremities and of the head, 
while the forearms, arms and legs remain natu- 
ral or grow but little. In addition, certain of 
the bones are misshapen, much as they are in 7 
the condition known as osteitis deformans. In 
a recent paper, Minkowski (Berlin. Klin. 
Woch., 1887, No 21) discusses this disease, 
and instances are there recorded in which 
enlargement of the pituitary body was found 
at the post-mortem. It seems then that 
evidences of overgrowth of tissue may be ex- 
pected in the cases of tumor or hypertrophy 
of the hypophysis cerebri, whether this mani- 
fest itself merely in a tendency to grow 
stout or in the aggravated condition known 
as acromegaly. In the case just recorded no 
acquired hypertrophy or deformity of any 
tissue was present, except the tumor of 
the face, although there certainly was 
this tendency to grow stout. Inasmuch 
as the very presence of a tumor in sella ti r- 
cica in this case is merely a matter of sur- 
mise, it is perhaps idle to speculate upon 
what the nature of the growth plight be. At 
the same time, it is not uninteresting to re- 
member in this connection the tumor of the 
face and upper part of the neck. This bore 
the clinical characteristics of a subcutaneous 
venous naevus, inasmuch as it became dis- 
tended when the patient stooped over, and 
again diminished in size when she assumed 
the erect posture. This growth began to en- 
large in the patient’s ninth year, at about 
which time, or a little later, the commence- 
ment of her present disabilities occurred. It 
is not unreasonable then to assume that at the 
same time an hypertrophy of the tissues of 
the pituitary body took place, an hypertrophy, 
moreover, akin in its pathological nature to 
that of the growth upon the face. Be this as $ 
it may, the symptoms in this case have 
been quite certainly produced by some form 
of pressure in the neighborhood of the optic 
chiasma, and from comparisons of other sim- 
ilar reported cases it is not unlikely that 
this pressure has been occasioned by an over- 
growth of the tissues in the sella turcica.