Test Your Knowledge

The purpose of this submission is to allow trainees to practice reviewing neuroimages for lesion localization and expected neuro-ophthalmologic findings. Case 1 is an MR image of a large planum sphenoidale meningioma with an associated multiple choice question regarding the expected ocular findings. There is an answer key with a description of the type of MRI presented, patient diagnosis, ocular findings and brief treatment course.

Test Your Knowledge! Zoë R Williams, MD University of Rochester School of Medicine Flaum Eye Institute Associate Professor of Ophthalmology, Neurology and Neurosurgery What are the expected ocular findings from this lesion? A. Gaze evoked nystagmus and CN III palsy B. Bilateral optic neuropathy and bitemporal hemianopia C. Homonymous hemianopia and convergence retraction nystagmus D. Skew deviation and upbeat nystagmus Planum sphenoidale meningioma Answer B • Planum sphenoidale meningiomas enlarge slowly displacing the frontal lobes and causing optic chiasm compression. • The sagittal and coronal T1 FLAIR MRI with fat suppression and contrast show a large planum sphenoidale meningioma which caused slowly progressive bilateral vision loss and change in personality. Neuro-ophthalmologic exam showed bilateral compressive optic neuropathy with bitemporal hemianopia due to chiasmal compression. There was significant visual recovery with resection and radiation therapy. Echalier EL, Subramanian PS. Meningiomas of the planum sphenoidale and tuberculum sella. J Neurol Surg B Skull Base. 2021 Feb; 82(1): 72-80.