Paracentral Bitemporal Hemianopsia and Acquired Supranuclear Ocular Motor Paresis Following Cardiac Surgery

Calvin W Wong; Ahmad Kharsa; Noor Adnan Rashid Laylani; Pamela Davila Siliezar; Andrew G Lee

doi:10.7759/cureus.44108

Paracentral Bitemporal Hemianopsia and Acquired Supranuclear Ocular Motor Paresis Following Cardiac Surgery

Cureus. 2023 Aug 25;15(8):e44108. doi: 10.7759/cureus.44108. eCollection 2023 Aug.

Authors

Calvin W Wong¹, Ahmad Kharsa², Noor Adnan Rashid Laylani³, Pamela Davila Siliezar³, Andrew G Lee^{3

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Affiliations

¹ McGovern Medical School, University of Texas Health Science Center at Houston, Houston, USA.
² John Sealy School of Medicine, University of Texas Medical Branch, Houston, USA.
³ Department of Ophthalmology, Houston Methodist Hospital, Houston, USA.
⁴ Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Medical College of Cornell University, New York, USA.
⁵ Department of Ophthalmology, University of Texas Medical Branch, Galveston, USA.
⁶ Department of Ophthalmology, University of Texas MD Anderson Cancer Center, Houston, USA.
⁷ Texas A&M School of Medicine, Texas A&M University, Bryan, USA.
⁸ Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, USA.

Abstract

Acquired supranuclear ocular motor paresis (ASOMP) is a rare complication following cardiac surgery, characterized by limited voluntary eye motility. The exact cause and development of ASOMP after cardiac surgery remain unclear. We report a case of ASOMP with paracentral bitemporal hemianopsia with optic atrophy after cardiac surgery, which, to our knowledge, is novel. The patient demonstrated bilateral ophthalmoplegia, with gradual improvement in voluntary smooth pursuit but persistent impairment in saccadic eye movements. Interestingly, the patient showed improved proprioceptive-driven pursuit of their own hand compared to pursuit or saccades following an examiner's hand. The visual field examination revealed a bilateral paracentral temporal hemianopic field defect. The underlying mechanisms of ASOMP and potential chiasmal ischemia in this case remain unknown. Clinicians should be aware of the possibility of ASOMP following cardiac surgery, with potential slow improvement over time.

Keywords: asomp; chiasmal stroke; gaze palsy; lateral gaze palsy; ophthalmoplegia.

Publication types

Case Reports