Bilateral Superior Altitudinal Hemianopsia with Macular Involvement Confirmed by Multifocal Visual Evoked Potential Testing

We report a case of bilateral superior altitudinal hemianopsia (BSAH) secondary to pituitary microadenoma related inferior optic chiasm damage. A 69-year-old-female developed a BSAH with macular involvement that was initially considered as malingering due to the obscurity of this symptom. The patient presents with multiple risk factors for ischemic disease to the ocular and occipital vessels, persistent migraine, hypothyroidism, and a stable pituitary microadenoma, yet no evidence of tissue ischemia or infarction was noted on imaging that could account for her visual field defects. A prior history of pituitary microadenoma is presumed to be the etiologic cause although the lesion had regressed by the time of presentation.