J Korean Ophthalmol Soc.  2016 Nov;57(11):1821-1825. 10.3341/jkos.2016.57.11.1821.

A Case of Meningioma Masquerading as Ischemic Optic Neuropathy

• Kim JE
• Chang MH
• Kyung SE

• KMID: 2357744
• DOI: http://doi.org/10.3341/jkos.2016.57.11.1821

Abstract

PURPOSE
We report a case of meningioma diagnosed as ischemic optic neuropathy.
CASE SUMMARY
A 45-year-old women presented with decreased visual acuity in her left eye without eye movement pain. Her best corrected visual acuity (BCVA) in that eye was 0.3. She showed a relative afferent pupillary defect, abnormal color vision test, and inferior visual field defect in her left eye. The optic disc showed slight blurring superiorly and pallor temporally. Fluorescein angiography showed choroidal filling defect, and ischemic optic neuropathy was suspected. The carotid artery sonography showed normal results. The BCVA of the left eye was 0.5 after 7 months. The visual field test and color vision test were improved after 7 months. The optic disc was pale. The magnetic resonance imaging was performed because of persistent headache, and that showed a suprasellar mass that was removed by surgical resection and diagnosed as meningioma on biopsy.
CONCLUSIONS
The possibility of compressive optic neuropathy should be considered in presumed ischemic optic neuropathy if the patient complains of persistent headache.

Keyword

Compressive optic neuropathy; Ischemic optic neuropathy; Suprasellar meningioma

MeSH Terms

Biopsy
Carotid Arteries
Choroid
Color Vision
Eye Movements
Female
Fluorescein Angiography
Headache
Humans
Magnetic Resonance Imaging
Meningioma*
Middle Aged
Optic Nerve Diseases
Optic Neuropathy, Ischemic*
Pallor
Pupil Disorders
Visual Acuity
Visual Field Tests
Visual Fields

Figure

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  Figure 1. Humphrey visual field test at the first visit. (A) The test showed inferior arcuate defect with central scotoma in left eye. (B) No defect in right eye.

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  Figure 2. The left optic disc at the first visit. The slight blurred superiorly and pallor temporally optic disc was suspected to be ischemic optic neuropathy.

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  Figure 3. The optical coherence tomography at the first visit. The test showed decreased retinal nerve fiber layer (RNFL) thickness temporally of left eye corresponding to optic disc pallor. ONH = optic nerve head; OU = oculus unitas; OD = oculus dexter; OS = oculus sinister; C/D = cup/disc; TEMP = temporal; SUP = superior; NAS = nasal; INF = inferior; S = superior; N = nasal; I = inferior; T = temporal.

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  Figure 4. Fluorescein angiograph of left eye. The test showed delayed peripapillary choroidal filling at 12 seconds that was suspected to be ischemic optic neuropathy at the first time.

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  Figure 5. Humphrey visual field test in left eye at 7 months. The test showed improvement compared to that of at the first visit after steroid therapy.

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  Figure 6. Brain magnetic resonance image. (A) 2.7 × 2.3 cm sized well circumscribed mass (white arrowheads) of left suprasellar area with direct contact to optic chiasm in axial T1-enhanced images. (B) Low signal intensity mass intensified higher than gray matter in transverse T2-weighted images (white arrowheads).

Reference

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