CONTRALATERAL OPTIC NEUROPATHY IN SPHENOID WING MENINGIOMA WITH MIDBRAIN COMPRESSION
Inderpreet K., Ayeesha M. Z., Rupini Y., Norshamsiah M. D. & Jemaima C. H.
abstract
A 38-year-old lady presented with progressively worsened binocular diplopia for 2 months associated with periorbital pain, headache, nausea and right sided tinnitus. Ophthalmic examination revealed Left Relative Afferent Pupillary Defect (RAPD) with impaired optic nerve function and right 6th cranial nerve palsy. Fundus examination showed bilateral optic disc swelling, more in the left eye. Humphrey Visual field showed left superior quadrant field defect. MRI Scan revealed right sphenoid meningioma with midline shift causing compression of the adjacent ventricle. She underwent preoperative angioembolization of the tumour followed by right craniotomy and tumour excision. Post-operatively, the diplopia, RAPD, optic disc swelling and visual field defect resolved. Optic neuropathy may be worst on the contralateral side of a space-occupying lesion despite bilateral optic disc swelling.
references
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2. Ruddy J, Cardenas AC. Hemianopsia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited 2023 Feb 13]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK562262/
3. Goodwin D. Homonymous hemianopia: challenges and solutions. Clin Ophthalmol. 2014 Sep 22;8:1919–27.
4. Donaldson L, Rebello R, Rodriguez AR. Relative Afferent Pupillary Defect with Normal Vision: Unique Localisation to the Contralateral Brachium of the Superior Colliculus. Neuroophthalmology. 2019 Dec 12;44(2):128–30.
5. Visual outcome predictors after surgical excision of meningiomas compressing the optochiasmatic complex | Egyptian Journal of Neurosurgery | Full Text [Internet]. [cited 2022 Oct 31]. Available from: https://ejns.springeropen.com/articles/10.1186/s41984-020-00088-5
6. Taha ANM, Erkmen K, Dunn IF, Pravdenkova S, Al-Mefty O. Meningiomas involving the optic canal: pattern of involvement and implications for surgical technique. FOC. 2011 May;30(5):E12.