A Diagnostic Conundrum of Bilateral Optic Disc Edema

We present an interesting diagnostic dilemma related to an intracranial disease with ocular involvement. Multiple imaging modalities failed to distinguish inflammatory from neoplastic etiology.

UPFRONT Case Section Editor: Larry Frohman, MD A Case of Suspected nabpaclitaxelAssociated Maculopathy T his case presents a complex patient with cancer who is followed by neuro-ophthalmology for compressive optic neuropathy secondary to a primary pituitary macroadenoma. He was found to have drug-induced cystoid macular edema (CME) while being treated with nabpaclitaxel (Abraxane)–gemcitabine chemotherapy for metastatic pancreatic adenocarcinoma. Maculopathy is a rare complication associated with paclitaxel. In complex oncologic patients, vision may be affected by multiple etiologies; although stopping chemotherapy may lead to resolution of drug-induced CME, the decision is not to be taken lightly and requires a multidisciplinary approach. The case is available to download through the following link: https://journals.na.lww.com/jneuro-ophthalmology/Documents/JNO%20Upfront%20Cases/UPFRONT% 20Case%2017%20-%20A%20Case%20of%20Suspected %20Paclitaxel-associated%20Maculopathy.pptx. A Diagnostic Conundrum of Bilateral Optic Disc Edema W e present an interesting diagnostic dilemma related to an intracranial disease with ocular involvement. Multiple imaging modalities failed to distinguish inflammatory from neoplastic etiology. Primary central nervous system lymphoma (PCNSL) with CD-10 positivity and no associated systemic lymphoma is a rare presentation. Although disc edema is a rare presentation in PCNSL, it can happen secondary to optic nerve infiltration by lymphoma cells. Early diagnosis and initiation of treatment for lymphoma help to preserve the vision. Headache, Confusion, and Hearing Loss O ur UPFRONT presentation is a case of a 43-year-old woman who presented with progressively worsening encephalopathy and hearing loss. She was found to have bilateral, multiple branch retinal artery occlusions on fluorescein angiography and characteristic hyperintense corpus callosum lesions on MRI T2/fluid-attenuated inversion recovery image. The case is available to download via the following link: https://journals.lww.com/jneuro-ophthalmology/Documents/JNO%20Upfront%20Cases/UPFRONT%20Case %2019%20-%20Headache%2C%20Confusion%2C% 20and%20Hearing%20Loss.pptx. e40 Denis Huang, MD Neesurg S. Mehta, MD Kit W. Tam, MD Kareem Moussa, MD Yin Allison Liu, MD, PhD Departments of Ophthalmology and Vision Science (DH, NSM, KM) and Hematology and Oncology (KWT), and Ophthalmology and Vision Science, Neurology, and Neurological Surgery (YAL), University of California, Davis, Sacramento, California. Address correspondence to Yin Allison Liu, MD, PhD, UC Davis Eye Center, University of California, Davis, 4860 Y Street, Suite 2400, Sacramento, CA 95817; E-mail: [e-mail] Y. A. Liu is supported in part by the UC Davis Paul Calabresi Career Development Award for Clinical Oncology as funded by the National Cancer Institute/National Institutes of Health through Grant No. #2K12CA138464-11. The authors report no conflicts of interest. The case is available to download through the following link: https://journals.lww.com/jneuro-ophthalmology/Documents/ JNO%20Upfront%20Cases/UPFRONT%20Case%2018% 20-%20A%20Diagnostic%20Conundrum%20of%20Bilateral %20Optic%20Disc%20Edema.ppsx. Praveen Jeyaseelan, MD Andrew R. Carey, MD Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland. Address correspondence to Yin Allison Liu, MD, PhD, UC Davis Eye Center, University of California, Davis, 4860 Y Street, Suite 2400, Sacramento, CA 95817; E-mail: [e-mail] The authors report no conflicts of interest. Abigail P. Jebaraj, MD Samuel W. Wilkinson, MD Jacob R. Nydegger, BA Meagan D. Seay, DO Department of Ophthalmology and Visual Sciences (APJ, SWW, MDS), John A Moran Eye Center, Salt Lake City, Utah; and Honors College (JRN), University of Utah, Salt Lake City, Utah. Address correspondence to Yin Allison Liu, MD, PhD, UC Davis Eye Center, University of California, Davis, 4860 Y Street, Suite 2400, Sacramento, CA 95817; E-mail: [e-mail] The authors report no conflicts of interest. UPFRONT Case: J Neuro-Ophthalmol 2023; 43: e40 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited.