Assessment rules out life- or Limb- threatening injuries

A 43-year-old man presents to an acute care clinic following motor vehicle accident. He is visibly shaken, and your initial assessment rules out life- or limb- threatening injuries. On secondary assessment you notice coarse facial features including a prominent jaw, very large hands and feet, and a husky voice.

Upon examination of the cranial nerves, you’re sure he has a definite loss of lateral peripheral vision in both eyes. This leads you to inquire about the details of the motor vehicle accident, to which he says he didn’t see the other car. You then ask to see the photo of his driver’s license.

The photo is only 9 years old, but the pictured facial features are quite normal. The patient is 5’9” and weighs 180 lbs. With further questioning you learn that his shoe size, glove size, and ring size have been increasing in recent years.

You tell him you think the accident did not hurt him, but you would like to refer him to an optometrist for formal visual field testing. You suspect that, in the end, this patient will need to see a neurosurgeon.

Questions:

1. What condition do you think this patient may be suffering from? Explain your rational.

2. On the basis of the MR image below (arrow), how can you explain the vision loss?

3. What is the treatment for the condition the patient is suffering from?