| OCR Text |
Show Poster 32 All is Well - A diagnostic and management challenge Manasa Gunturu1, Mehdi Tavakoli1, Rochelle Freire2, Byron Lam1 Bascom Palmer Eye Institute, Miami, Florida, USA, 2University of Miami/ Jackson Memorial hospital, Miami, Florida, USA 1 Introduction: Ganglioglioma are rare, slow-growing neoplasm with high predilection for temporal lobe. Low-grade gangliogliomas typically curable by surgery and has excellent prognosis. High-grade gangliogliomas managed with total resection and sometimes followed by radiation. The cases reported in literature with edema in the optic chiasm and tract were secondary to sellar/suprasellar tumors, high grade gliomas, aneurysm and had visual dysfunction. Description of Case(s): A 48-year-old woman experienced 2 years of gradually worsening right hemiparesis. History of hypothyroidism on levothyroxine. Neurologic examination showed right lower face weakness and right hemiparesis with brisk reflexes and positive Babinski. Visual acuity was 20/15OU with no RAPD. Color vision, extraocular movements and fundus exam were normal. MRI-brain showed large heterogeneously enhancing solid-cystic lesion in left thalamus with extensive edema extending into optic chiasm and bilateral optic tracts. The ESR, CRP, ACE, ANA, RPR were normal. CT CAP did not reveal a systemic tumor. Stereotactic brain biopsy was non-diagnostic. Oral prednisone was initiated. HVF, OCT RNFL, OCT Ganglion cell layers OU were normal. Repeat imaging after two weeks of oral steroids, showed no change in lesion size with some improvement in edema. Brain PET scan showed small focus of increased FDG activity in the lesion. Repeat biopsy favored WHO grade1 ganglioglioma. Although pathologically it was low-grade, patient declined clinically and radiologically. She was started on bevacizumab followed by temozolamide. Significant improvement was noted on follow-up brain imaging and clinically. Conclusions, including unique features of the case(s): The relatively mild initial neurologic symptoms and the lack of visual dysfunction with intact RNFL and GCL despite extensive radiologic involvement of the lesion was a diagnostic dilemma in the face of a non-diagnostic brain biopsy. A second biopsy revealed grade 1 ganglioglioma and treatment was challenging as the tumor was deemed not resectable due to the location, requiring radiation followed by chemotherapy. References: A national perspective of adult gangliogliomas Kunal Varshneya, J. Manuel Saemiento, Mirian Nuno, Carlito Lagman, Debraj Mukherjee, Karla Nuno, Harish Babu, Chirag G Patil (August 2016) Cerebral Gangliogliomas: Preoperative Grading using FDG-PET and 201Tl-SPECT Patricia K. Kincaid, Suzie M. El-Saden, SungHye Park, and Barry W. Goy (may 1998) Intracranial ganglioglioma: clinicopathological and MRI findings in 16 patients D. Zhanga, T.D. Henningb, L.-G. Zoua, L.-B. Huc, L. Wena,*X.-Y. Fengd, S.-H. Daia, W.-X. Wanga, Q.-R. Suna, Z.-G. Zhange (Jan 2008) Reversible Edema-Like Changes Along the Optic Tract Following Pipeline-Assisted Coiling of a Large Anterior Communicating Artery Aneurysm. Biagia La Pira; Waleed Brinjikji; Christopher Hunt; John J Chen; Giuseppe Lanzino MR imaging study of edema-like change along the optic tract in patients with pituitary region tumors. Saeki N, Uchino Y, Murai H, Kubota M, Isobe K, Uno T, Sunami K, Yamaora A. AJNR Am J Neuroradiol. 2003 Oedema along the optic tracts due to pituitary metastasis. Saeki N, Murai H, Kubota M, Fujimoto N. Br J Neurosurg. 2001. Keywords: Tumors, Neuroimaging, Higher visual functions, Diagnostic Tests (ERG, VER, OCT, HRT, mfERG, etc), Eyelid & adnexal disease Financial Disclosures: The authors had no disclosures. Grant Support: None. 88 | North American Neuro-Ophthalmology Society |
