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Park, Seol, Choi, and Lee: A Case of Suprasellar Arachnoid Cyst with Compressive Optic Neuropathy
Case Report
Journal of the Korean Ophthalmological Society

Journal of the Korean Ophthalmological Society 2012; 53(10): 1532-1539.

Published online: 17 October 2012

DOI: https://doi.org/10.3341/jkos.2012.53.10.1532

A Case of Suprasellar Arachnoid Cyst with Compressive Optic Neuropathy

Jong Ho Park, MD1, Eu Ri Seol, MD2, Hee Young Choi, MD, PhD1, Ji Woong Lee, MD1

1Department of Ophthalmology, Pusan National University College of Medicine, Busan, Korea.

2Department of Radiology, Pusan National University College of Medicine, Busan, Korea.

Address reprint requests to Ji Woong Lee, MD. Department of Ophthalmology, Pusan National University Hospital, #179 Gudeok-ro, Seo-gu, Busan 602-739, Korea. Tel: 82-51-240-7326, Fax: 82-51-242-7341, alertlee@hanmail.net

Received 31 October 2011       Accepted 18 August 2012

Copyright © 2012 The Korean Ophthalmological Society

Abstract

Purpose

To report a case of suprasellar arachnoid cyst with compressive optic neuropathy.

Case summary

A 50-year-old man presented with decreased visual acuity in the right eye of 6 months duration. Best corrected visual acuity was 0.2 in the right eye, 1.0 in the left eye, and the intraocular pressure was 13 mm Hg in the right eye, and 18 mm Hg in the left eye. Fundus examination showed pale optic disc in the right eye and retinal nerve fiber layer defects in both eyes. Visual field examination revealed a central visual field of 10° in the right eye and an inferior visual field defect in the left eye. The brain magnetic resonance image (MRI) showed a suprasellar arachnoid cyst that compressing the optic nerve and chiasm.

Conclusions

The author experienced arachnoid cyst accompanied by optic disc atrophy and visual field defect in a patient diagnosed and treated for glaucoma. In cases of non-specific clinical features that differ from typical glaucomatous presentations, the utilization of brain MRI appears to be helpful in diagnosis and treatment.

Keywords: Arachnoid cyst, Compressive optic neuropathy, Normal tension glaucoma

Figures and Tables

Figure 1
Retinal nerve fiber layer (RNFL) and disc photographs of the patient at initial visit. Cup-disc ratio is 0.68 in the right eye (A) and 0.52 in the left eye (B). Greater pallor than cupping is observed in the optic disc of the right eye (A). Diffuse RNFL defects in the right eye (C). Note superior and inferior RNFL defects, but a relatively intact neuroretinal rim in left eye (D).
jkos-53-1532-g001
Figure 2
Optical coherence tomography (OCT) (A) and Heidelberg retinal tomography (HRT) (B). Diffuse retinal nerve fiber layer defects were detected in the RNFL thickness deviation map on OCT in the right eye with abnormal Moorfield Regression Analysis (MRA) on HRT. There are superior and inferior RNFL defects on the RNFL thickness deviation map of OCT in the left eye with normal MRA on HRT.
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Figure 3
Note the infero-nasal step defect in the left eye (A) and inferior altitudinal and superior arcuate visual field defects in the right eye (B) at initial visit. After 18 months, the visual field index (VFI) and mean deviation (MD) decreased in both eyes and pattern standard deviation (PSD) increased in the both eyes (C, D). Central visual field remained within 10° at initial visit, but it decreased within 5° after 18 months.
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Figure 4
P100 amplitude of right eye decreased more severely than that of the left eye and P100 latency delayed in both eyes.
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Figure 5
The patient's brain MRI. (A) Transverse T2-weighted scan shows suprasellar cistern enlargement due to arachnoid cysts (black arrowheads). (B) Coronal T2-weighted scan shows elevated optic nerve (red arrow), elongated pituitary stalk (black arrow) due to arachnoid cyst (black arrowheads). (C) Sagittal T1-weighted scan shows optic nerve compression (red arrow) due to arachnoid cyst (white arrowheads).
jkos-53-1532-g005

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