A Case of Meningioma Masquerading as Ischemic Optic Neuropathy

Ju Eun Kim; Moo Hwan Chang; Sung Eun Kyung

doi:10.3341/JKOS.2016.57.11.1821

Journal List > J Korean Ophthalmol Soc > v.57(11) > 1010467

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Kim, Chang, and Kyung: A Case of Meningioma Masquerading as Ischemic Optic Neuropathy

Case Report

J Korean Ophthalmol Soc 2016;57(11):1821-1825.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/JKOS.2016.57.11.1821

A Case of Meningioma Masquerading as Ischemic Optic Neuropathy

Ju Eun Kim, MD, Moo Hwan Chang, MD, PhD, Sung Eun Kyung, MD, PhD

Department of Ophthalmology, Dankook University College of Medicine, Cheonan, Korea

Address reprint requests to Sung Eun Kyung, MD, PhD Department of Ophthalmology, Dankook University Hospital, #201 Manghyang-ro, Dongnam-gu, Cheonan 31116, Korea Tel: 82-41-550-6479, Fax: 82-41-561-0137 E-mail: kseeye@hanmail.net

Received 11 August 2016 Revised 27 September 2016 Accepted 25 October 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Compressive optic neuropathy, Ischemic optic neuropathy, Suprasellar meningioma

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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.

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.

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.

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.

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.

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).

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