Background/Objectives: Visual impairment is an underrecognized but functionally disabling complication of stroke that adversely affects rehabilitation potential, autonomy, and quality of life. Clinical, anatomical, and ophthalmologic determinants of post-stroke visual recovery remain incompletely defined, particularly in Eastern European tertiary stroke units where structured visual follow-up is not standardized. This study aimed to identify clinical, imaging, and ophthalmologic predictors of favorable visual recovery and to evaluate whether integrating these domains improves early prognostic stratification beyond standard neurological assessment. Methods: We conducted a retrospective single-center cohort study of 71 consecutive adult patients admitted with acute stroke and a documented visual complication between January 2022 and September 2025 at Pius Brinzeu Emergency County Hospital and Victor Babes University of Medicine and Pharmacy Timisoara. Favorable recovery was defined as ≥50% improvement in visual field index (VFI) at 6 months. Group comparisons used Student's t-test, Mann-Whitney U test, chi-square test, and Fisher's exact test. Multivariable logistic regression, Cox proportional hazards modeling, and unsupervised k-means clustering were performed. Results: Twenty-nine patients (40.8%) achieved favorable recovery, while 42 (59.2%) had persistent impairment. Responders were younger (62.8 ± 10.7 vs. 70.4 ± 10.8 years, p = 0.005) and had lower admission National Institutes of Health Stroke Scale (NIHSS) (6.4 ± 2.9 vs. 10.3 ± 4.4, p < 0.001), smaller lesion volumes (18.7 ± 11.4 vs. 33.2 ± 18.7 mL, p < 0.001), thicker peripapillary retinal nerve fiber layer (89.3 ± 7.6 vs. 78.2 ± 9.4 μm, p < 0.001), and earlier rehabilitation initiation (11.4 ± 5.3 vs. 21.7 ± 9.8 days, p < 0.001). NIHSS, time to rehabilitation, and optical coherence tomography (OCT) pRNFL thickness remained independent predictors. The full integrated model achieved an area under the receiver operating characteristic curve (AUC) of 0.87. Cluster analysis identified three distinct phenotypes with favorable recovery rates of 79.2%, 34.8%, and 8.3%. Conclusions: Combined clinical, neuroimaging, and ophthalmologic profiling-particularly OCT pRNFL-meaningfully refines early prediction of post-stroke visual recovery and supports phenotype-driven rehabilitation planning.

Introduction Pituitary adenomas are among the most commonly encountered intracranial neoplasms requiring surgical intervention. Although endoscopic endonasal transsphenoidal surgery has become the preferred minimally invasive approach, open transcranial surgery continues to be indicated for selected invasive or anatomically complex lesions. Comparative outcome data from resource-limited tertiary institutions are still scarce. Therefore, this study aimed to evaluate the clinico-demographic characteristics and perioperative outcomes of patients with pituitary adenoma who underwent open or endoscopic pituitary surgery at a tertiary government hospital over five years. Methods A retrospective cohort descriptive-analytic study was conducted involving patients diagnosed with pituitary adenoma who underwent either open transcranial surgery or endoscopic transnasal transsphenoidal surgery at Vicente Sotto Memorial Medical Center from January 2018 to December 2022. Demographic characteristics, presenting symptoms, endocrine profiles, perioperative complications, mortality, length of hospital stay, and discharge outcomes were reviewed. Comparative analyses between surgical groups were performed using Fisher's exact test and Mann-Whitney U test, with statistical significance set at p < 0.05. Results A total of 67 patients were included, of whom 18 (26.9%) underwent open surgery, and 49 (73.1%) underwent endoscopic surgery. Patients who underwent open surgery were older than those managed endoscopically (50.83 ± 11.26 years vs. 46.75 ± 12.11 years). Visual symptoms predominated in both groups, particularly blurring of vision and bitemporal hemianopsia. Non-functioning adenomas represented the majority of tumors in both cohorts (14; 77.8% vs. 40; 81.6%). Mean prolactin levels were markedly higher in the open surgery group (194.38 ± 633.28 ng/mL vs. 54.62 ± 103.17 ng/mL). The endoscopic cohort demonstrated a shorter mean hospital stay (21.41 ± 15.87 days vs. 23.67 ± 17.62 days), although the difference was not statistically significant (p = 0.512). Diabetes insipidus was the most common postoperative complication in both groups, occurring more frequently following open surgery (n = 5; 27.8% vs. n = 8; 16.3%). Cerebrospinal fluid rhinorrhea occurred exclusively in the endoscopic cohort (n = 3; 6.1%), whereas anemia and cavernous sinus injury were observed only in the open surgery group. Mortality rates were higher in the open surgery cohort (n = 2; 11.1% vs. n = 2; 4.1%), although no statistically significant differences were identified in complication rates, mortality, or discharge disposition between approaches. Most patients demonstrated postoperative improvement or recovery, particularly in the endoscopic cohort (n = 45; 91.8%). Conclusions Both open and endoscopic surgical approaches demonstrated favorable clinical outcomes in the management of pituitary adenomas. Endoscopic surgery was associated with shorter hospitalization and high postoperative recovery rates, supporting its role as the preferred minimally invasive approach for appropriately selected patients, while open surgery remained essential for complex lesions. These findings highlight that safe and effective pituitary surgery can be achieved in a tertiary government hospital within a resource-limited setting.

Patterns of visual loss are the key to anatomic localization. Strictly monocular defects map to the prechiasmal sensory visual system. Bitemporal hemianopia is the signature of damage to the optic chiasm. Incongruous homonymous hemianopia points to an optic tract lesion. The closer a lesion gets to the occipital cortex, the more congruous or similar are the patterns of homonymous hemianopia. Understanding these patterns will add an important dimension to the clinician's localization arsenal. Perimetry is the quantitation of the visual field. This is done with a perimeter and usually involves estimating visual thresholds with a range of light stimuli. It is used clinically to map patterns of visual loss due to damage to the sensory visual system. This chapter discusses the types of perimetric testing and the underlying psychophysics of perimetry. This is followed by the interpretation of perimetric results, the relevant visual system anatomy, and patterns of loss helpful for neurologic localization. Lastly, the difficult issue of deciding whether the visual field has changed is reviewed.

We report the case of a 30-year-old woman with no relevant medical history who presented with a new-onset headache associated with nausea, vomiting, photophobia, phonophobia, and right nasal hemianopsia. Ocular point of care ultrasound (POCUS) examination revealed a hyperechoic lesion adhered to the vascular layer that did not move with eye movements. The patient was referred to ophthalmology, where choroidal melanoma was confirmed. Extension studies showed no metastases, and enucleation was performed. This case highlighted the importance of ocular POCUS in the diagnostic approach to this patient.

We report a case of Foster Kennedy Syndrome (FKS) caused by a frontal lobe tumor in which the optic disc (OD) shape was first monitored by optical coherence tomography (OCT) before and after tumor removal. A 56-year-old male complained of decreased vision in the left eye and an abnormal visual field in both eyes. The OD showed swelling and redness in the right eye and paleness in the left eye. OCT was used to measure the thickness of the retinal nerve fiber layer (RNFL) and the optic nerve head (ONH). The average OD thickness in the right and left eyes was 647 and 335 μm, respectively. Goldmann perimetry revealed an enlarged Mariotte blind spot with paracentral scotoma in the right eye and central absolute scotoma with horizontal hemianopsia in the left eye. FKS was suspected, and MRI revealed a lobulated mass outside the brain parenchyma of the anterior base of the skull, severely compressing both the frontal lobes and the corpus callosum. The patient underwent surgery for tumor removal. Six months after surgery, the visual field improved, but a central scotoma remained in the left eye. The OD thickness in the right and left eyes was 360 and 279 μm, respectively. RNFL thickness decreased preoperatively in both eyes, reaching the atrophic range in the left eye. In conclusion, OCT analysis revealed edema in the swollen OD and in the atrophic one in FKS. Notably, the ONH may be within the normal range in the early stages of the disease.