1/13. A new approach to an old problem.A patient with progressive visual loss was found to have an optic nerve sheath meningioma. The patient was treated with stereotactic radiotherapy, a computer-guided stereotactic technique that minimizes the risk of radiation-induced optic neuropathy. Six months after treatment, the patient was doing well and showed no signs of radiation-induced optic neuropathy.- - - - - - - - - - ranking = 1keywords = neuropathy (Clic here for more details about this article) |
2/13. Melanocytoma of the left optic nerve head and right retrobulbar optic neuropathy compressed by a tuberculum sellae meningioma.A 40-year-old woman had a highly pigmented, slightly elevated tumor on the left optic disc. She had no visual disturbance in the left eye. The tumor was stationary for 5 years. At age 45 years, she complained of decreased visual acuity in the right eye. magnetic resonance imaging showed a right-shifted homogeneous lesion at the tuberculum sellae. Histopathologic study of the excised lesion revealed interlacing bundles of spindle-shaped fibroblast-like cells with whorl formation. We believe that a relationship between melanocytoma of the optic nerve head and a tuberculum sellae meningioma may exist rather than a chance occurrence, as previously suggested by others.- - - - - - - - - - ranking = 2keywords = neuropathy (Clic here for more details about this article) |
3/13. Systemic non-Hodgkin's lymphoma with optic nerve infiltration in a patient with AIDS.PURPOSE: To report the clinicopathologic features of a patient with AIDS and clinically regressed systemic non-Hodgkin's lymphoma who subsequently developed lymphomatous infiltration of the optic nerve and occlusion of the central retinal vein in both eyes. methods: The eyes of this patient were examined ophthalmologically and by fluorescein angiography. The eyes, brain, and body were obtained after death and studied by light microscopy. RESULTS: Ophthalmic examination and fluorescein angiography revealed optic nerve swelling and central retinal vein occlusion first in the left eye and shortly thereafter in the right eye. Postmortem histopathologic examination showed dense infiltration of both optic nerves by lymphoma as well as necrotizing vasculitis involving the retinal vessels near the left optic nerve head. Examination of the brain revealed lymphomatous involvement in the paraventricular region with associated necrosis and inflammation. No bone marrow recurrence or other residual systemic lymphoma was present. CONCLUSION: This case demonstrates that infiltrative optic neuropathy may occur as the sole ocular manifestation of disease recurrence in a patient with systemic non-Hodgkin's lymphoma otherwise thought to be in clinical remission.- - - - - - - - - - ranking = 0.5keywords = neuropathy (Clic here for more details about this article) |
4/13. optic nerve sheath meningiomas: visual improvement after stereotactic radiotherapy.OBJECTIVE: The management of primary optic nerve sheath meningioma (ONSM) is controversial. Surgery often results in postoperative blindness in the affected eye and thus has been abandoned as a treatment option for most patients. When these tumors are left untreated, however, progressive visual impairment ensues, which also leads to blindness. Recently, radiation therapy has gained wider acceptance in the treatment of these lesions. Experience with stereotactic radiotherapy (SRT) in the treatment of ONSMs is limited because of the rare incidence of this tumor. We present a series of patients with ONSM who were treated with SRT. methods: Five patients (three women, two men), ranging in age from 40 to 73 years, presented with progressive visual loss with decreased visual field, visual acuity, and color vision affecting six eyes (one patient had tumor involving both optic nerves). One patient also presented with proptosis and diplopia. Five eyes had functional residual vision (range, 20/20 to 20/40), and one eye was completely blind. All five patients were diagnosed clinically and radiographically to have an ONSM. Three were intraorbital, one was intracanalicular as well as intraorbital, and one was a left ONSM extending through the optic foramen into the intracranial space and involving the right optic nerve. The five functional eyes were treated with SRT by use of 1.8-Gy fractions to a cumulative dose of 45 to 54 Gy. RESULTS: Follow-up ranged from 1 to 7 years, and serial magnetic resonance imaging revealed no changes in the size of the tumor in all five patients. Four patients experienced dramatic improvement in visual acuity, visual field, and color vision within 3 months after SRT. One patient remained stable without evidence of visual deterioration or disease progression. None had radiation-induced optic neuropathy. CONCLUSION: SRT may be a viable option for treatment of primary ONSM in patients with documented progressive visual deterioration, and it may be effective in improving or stabilizing remaining functional vision.- - - - - - - - - - ranking = 0.5keywords = neuropathy (Clic here for more details about this article) |
5/13. Prolonged premonitory optic disc signs in anterior ischemic optic neuropathy.A patient displayed a pink mass on the right optic disc and normal visual function that was diagnosed as a capillary hemangioma. Seven months later, he developed typical features of nonarteritic anterior ischemic optic neuropathy (NAION) in that eye. Such a long latency between "preeruptive" and "eruptive" disc edema has not been well documented in NAION.- - - - - - - - - - ranking = 2.5keywords = neuropathy (Clic here for more details about this article) |
6/13. Melanocytoma inducing compressive optic neuropathy: the ocular morbidity potential of an otherwise invariably benign lesion.PURPOSE: The purpose of this article is to document a case of melanocytoma of the optic nerve head inducing compressive optic neuropathy; to provide a summarized clinical review; and to reflect on the potential ocular morbidity aspects of this relatively benign insult. methods: We present a case report of a 32-year-old Hispanic woman with constant esotropia, inert tractional Toxacara granuloma in the right eye, and a jet-black lesion engulfing the left eye optic nerve head, with accompanying disk edema. RESULTS: A diagnosis of melanocytoma of the optic nerve with secondary compressive optic neuropathy was made on the basis of the clinical presentation. Patient education and quarterly follow-up visits to monitor the lesion were the recommended management. CONCLUSION: Although optic nerve head melanocytoma can be considered benign, it has the underlying potential to promote ocular morbidity. Our case report highlights the potential impact of melanocytoma on optic nerve head anatomy. The potential for even subtle changes in the visual fields from this condition becomes significant in a monocular patient. This is exemplified in this case, by the presence of a co-existing Toxacara granuloma and related amblyopia in the contralateral eye.- - - - - - - - - - ranking = 3keywords = neuropathy (Clic here for more details about this article) |
7/13. Carcinomatous optic neuropathy.A man with advanced malignant disease presented complaining of vision changes in the left eye. Examination revealed an afferent pupillary defect and visual field defect in that eye. Imaging indicated carcinomatous disease of the left optic nerve, and a diagnosis of carcinomatous optic neuropathy was made.- - - - - - - - - - ranking = 2.5keywords = neuropathy (Clic here for more details about this article) |
8/13. radiation retinopathy after fractionated stereotactic radiotherapy for optic nerve sheath meningioma.PURPOSE: To report a patient with radiation retinopathy after fractionated stereotactic radiotherapy for treatment of optic nerve sheath meningioma (ONSM). DESIGN: Interventional case report. methods: The clinical presentation, radiation treatment, and subsequent visual complications of a patient with ONSM are described. MAIN OUTCOME MEASURES: Development of radiation retinopathy and Snellen visual acuity. RESULTS: A 36-year-old man presented with a left optic neuropathy. magnetic resonance imaging studies showed abnormalities consistent with ONSM. Because of progressive vision loss, the patient underwent fractionated stereotactic radiotherapy for the lesion. Vision initially improved after treatment, but 22 months later, retinal abnormalities consistent with radiation retinopathy were noted in the left eye. visual acuity worsened over the next 24 months in association with the development of retinal hemorrhages, lipid, and retinal edema predominantly within the nasal portion of the posterior pole. fluorescein angiography showed edema associated with microaneurysms, retinal telangiectasia, and capillary nonperfusion. Laser photocoagulation was performed on several occasions in areas of microaneurysms and retinal telangiectasia; however, the retinal edema and lipid remained, associated with persistent decreased vision. CONCLUSIONS: radiation retinopathy and vision loss may occur after fractionated stereotactic radiotherapy for ONSM and should be discussed as a potential complication.- - - - - - - - - - ranking = 0.5keywords = neuropathy (Clic here for more details about this article) |
9/13. Postoperative progressive visual loss.A 61-year-old man was admitted with postoperative progressive bilateral visual loss following a parasagittal meningioma resection. No risk factor predisposing to an ischemic optic neuropathy was present and routine radiologic examinations did not reveal any pathology of the central or peripheral visual pathways. Mucin-positive adenocarcinoma cells were detected in the cytological examination and orbital MRI revealed metastatic infiltration of the optic chiasm and optic nerves. The primary site of the malignancy could not be established.- - - - - - - - - - ranking = 0.5keywords = neuropathy (Clic here for more details about this article) |
10/13. Presumed optic nerve sheath meningioma diagnosed after complicated retrobulbar anesthesia.We present a patient who developed acute visual loss and light flashes at retrobulbar anesthesia for cataract extraction. Vision improved only slightly after cataract surgery. Although traumatic optic neuropathy was suspected, the patient was diagnosed one year later with an optic nerve sheath meningioma (ONSM). ONSM is a rare, slow growing, benign tumour with highly variable clinical features. diagnosis is often delayed. This case report demonstrates the diagnostic difficulty of this tumour.- - - - - - - - - - ranking = 0.5keywords = neuropathy (Clic here for more details about this article) |
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