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Presentation typeE-poster
TitleCase report: An optic nerve glioma with intractable eye pain
PurposeWe present an atypical case of pilocytic astrocytoma, characterized by uncontrolable eye pain and discuss the role of optic nerve biopsy in unexplained progressive vision loss.
MethodsA 45 year-old woman presents for second opinion, while being treated for glaucoma elsewhere. Her visual fields had progressively deteriorated in the months before, despite adequate lowering of pressure. Fundoscopy, OCT, and visual fields were all consistent with bilateral optic atrophy. Since prior MRI and other extensive neurological work-up elsewhere was deemed unremarkable and there was no hope for visual gain, an optic nerve biopsy was suggested. Intractable eye pain one year later, led to bilateral evisceration. The development of additional neurological symptoms eventually led to euthanasia.
ResultsHistological examination of the optic nerve biopsy exposed a pilocytic astrocytoma (WHO grade I). Clinically, involvement of the optic chiasm was suspected, later to be confirmed on MRI.
Unfortunately, radio- and chemotherapy were unable to salvage vision at this stage.
ConclusionPilocytic astrocytoma usually occurs in children and is usually apparent on imaging. This case reminds us, it can also occur in adults, even with seemingly normal MRI. Despite being benign in nature, it can behave agressively and cause a lot of havoc. The message is to consider optic nerve biopsy in cases of unexplained progressive vision loss. Early diagnosis may help avoid additional morbidity and help extend the patient’s life.
Conflict of interestNo
Authors 1
Last nameBONTE
Authors 2
Last nameVAN LINT
Authors 3
Last nameDE GROOT
DepartmentZNA Middelheim
Authors 4
Last nameDE KEIZER
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