| Identifier |
walsh_2015_s3_c5-2 |
| Title |
Lights Out |
| Creator |
John J. Brinkley; John J. Chen; Patricia A. Kirby; Reid A. Longmuir; Matthew J. Thurtell |
| Affiliation |
(JJB) Eye Associates of New Mexico Albuquerque, NM; (JJC) Mayo Clinic Rochester, MN; (PAK) (RAL) (MJT) The University of Iowa, Iowa City, IA |
| Subject |
Binocular Vision Loss; Optic Atrophy; Optic Neuropathy; Intracranial Tumors |
| History |
A 78 year-old man presented with a one-month history of progressive painless binocular vision loss. Hehad sustained head trauma without loss of consciousness three days prior to the onset of vision loss. Onthe morning of his presentation to us, he had awoken with complete binocular vision loss and had beenstarted on oral prednisone (70 mg daily) by his local eye care provider. He denied symptoms of giantcell arteritis. His past medical history was remarkable for hypertension, diabetes, and a distant history ofprostate cancer that was thought to be in remission. Neurologic review of systems was unremarkable.Examination revealed no light perception OU. The pupils were dilated and minimally reactive to light.There was no RAPD. Intraocular pressures were within normal limits OU. Extraocular movements werefull OU. Anterior segment examination revealed pseudophakia OU. Dilated funduscopic examinationrevealed diffuse optic atrophy OU. Neurologic examination was unremarkable.There were no choroidal filling defects or perfusion abnormalities on fundus fluorescein angiography.ESR, CRP, and PSA were all within normal limits. MRI brain revealed enlargement and heterogeneousenhancement of the optic chiasm. An enhancing lesion was seen adjacent to the anterior horn of the rightlateral ventricle. CSF examination revealed markedly elevated protein and glucose levels, with negativecultures, cytology, and flow cytometry. Bone scan was negative for bony metastases. In an attempt toimprove his vision, intravenous methylprednisolone was given for five days, followed by a taper of oralprednisone over seven days. The right frontal lesion decreased in size dramatically with the steroidtreatment, making biopsy difficult, but his vision did not improve. Repeat MRI brain obtained twoweeks after completion of the steroids revealed interval growth of the right frontal lesion, withsurrounding vasogenic edema, and growth of the chiasmal lesion. A diagnostic procedure wasperformed. |
| Disease/Diagnosis |
Multicentric glioblastoma multiforme involving the optic chiasm |
| Date |
2015-02 |
| References |
1. Pallini R et al. Glioblastoma of the optic chiasm. J Neurosurg 1996; 84: 898-899. 2. Synowitz M et al. Multicentric glioma with involvement of the optic chiasm. Clin Neurol Neurosurg 2002; 105: 66-68. 3. Dinh TT et al. Glioblastoma of the optic chiasm. J Clin Neurosci 2007; 14: 502-505. 4. Abou-Zeid A et al. Blindness from multiple cerebral gliomas mimicking metastatic brain disease. Br J Neurosurg 2008; 22: 772-773. 5. Goh JJ et al. Vanishing glioblastoma after corticosteroid therapy. J Clin Neurosci 2009; 16: 1226-1228. 6. Matloob S et al. Multifocal malignant optic glioma of adulthood presenting as acute anterior optic neuropathy. J Clin Neurosci 2011; 18: 974-977. 7. Kang JJ et al. De novo malignant optic chiasm glioma with initial clinical response to steroids. Neuroophthalmology 2012; 36: 59-63. 8. Thomas RP et al. The incidence and significance of multiple lesions in glioblastoma. J Neurooncol 2013; 112: 91-97 |
| Language |
eng |
| Format |
application/pdf |
| Format Creation |
Microsoft PowerPoint |
| Type |
Text |
| Source |
47th Annual Frank Walsh Society Meeting |
| Relation is Part of |
NANOS Annual Meeting Frank B. Walsh Sessions; 2015 |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Walsh Session Annual Meeting Archives: https://novel.utah.edu/Walsh/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2013. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6ck1b3n |
| Setname |
ehsl_novel_fbw |
| ID |
179303 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6ck1b3n |
