Papilledema and bilateral optic neuropathy: dual mechanism for visual loss in patient with leptomeningeal carcinomatosis

Leptomeningeal carcinomatosis (LC) is rare complication of cancer involving spread of cancer cells into central nervous system via cerebrospinal fluid (CSF). Diagnosis can be difficult with contrast-enhanced magnetic resonance imaging (MRI) and cytological analysis of CSF for cancer both not sensitive enough to permit quick detection.

Poster 67 Papilledema and bilateral optic neuropathy: dual mechanism for visual loss in patient with leptomeningeal carcinomatosis Henry Liu1, Mohammed Alfalah2, Paul Freund2, Edward Margolin2 University of Ottawa, Faculty of Medicine, Ottawa, Canada, 2University of Toronto, Department of Ophthalmology & Vision Sciences, Toronto, Canada 1 Introduction: Leptomeningeal carcinomatosis (LC) is rare complication of cancer involving spread of cancer cells into central nervous system via cerebrospinal fluid (CSF). Diagnosis can be difficult with contrast-enhanced magnetic resonance imaging (MRI) and cytological analysis of CSF for cancer both not sensitive enough to permit quick detection. Description of Case(s): We present a rare case of patient with gastric adenocarcinoma with severe bilateral optic nerve head swelling. Two contrast-enhanced brain MRIs and two CSF analyses were non-diagnostic. Third brain MRI was initially interpreted as normal. Third CSF analysis revealed elevated opening pressure (28 cm of water) and extremely elevated protein levels but normal cytological analysis. MRI of the spine demonstrated diffuse leptomeningeal thickening and enhancing. When third brain MRI was reformatted, enhancement around both optic nerves and thickening of optic nerve sheaths was seen bilaterally which was felt to be compatible with carcinomatous seeding. Conclusions, including unique features of the case(s): Our case illustrates that patients with systemic malignancies presenting with bilateral optic nerve head edema might have both papilledema as well as bilateral optic neuropathy responsible for optic nerve swelling. It is also instructive in that despite very high disease load seen on spine MRI, two high volume CSF samples failed to demonstrate presence of malignant cells. References: None. Keywords: Tumors, Neuroimaging, Optic neuropathy Financial Disclosures: The authors had no disclosures. Grant Support: None. 122 | North American Neuro-Ophthalmology Society