Título / Title

DIAGNOSIS OF INTRACRANIAL EXPANSIVE LESION THROUGH OPHTHALMOLOGIC EXAMINATION

Introdução / Purpose

A 20 year-old male patient complained of blurred vision in OS for two weeks associated with emotional stress.

Material e Método / Methods

Retrospective study of chart review for a case report.

Resultados / Results

He had no previous comorbidities nor used any medication. Visual acuity (VA) OD 20/20 and OS 20/25. Anterior segment examination didn't reveal any alterations besides a mild anterior chamber reaction (+0.5/+4+) in both eyes.
At fundus examination in both eyes there was disc swelling and no other alterations. Image and laboratory tests were requested. Humprhey® campimetry 24:2 and 10:2 demonstrated in OD an enlarged blind spot and confluent scotomas in the extreme periphery of the upper nasal hemifield; in OS it demonstrated an enlarged blind spot and confluent scotoma in the extreme periphery of the upper nasal hemifield and an incomplete arcuate pattern. Labs ran negative for infectious diseases, chest X-ray without alterations.A hypothesis of optic neuritis was considered. Therapy with pulses of corticosteroids started for 3 days with a gradual reduction plan. After pulse therapy VA improved to 20/20 for both eyes, however disc swelling remained present. On the same day he was able to perform a cranial magnetic resonance imaging, which detected a left frontotemporal extra-axial expansive tumor measuring about 7.2 x 6.5 x 4.6 cm with signs of transtentorial herniation. The diagnostic hypothesis was hemangiopericytoma. Neurosurgery team who indicated urgent surgery for tumor excision.

Discussão e Conclusões / Conclusion

Increased intracranial pressure, due to a massive lesion, leads to axons' edema and cellular loss which results in papilledema. Associated symptoms range from headache, nausea and vomiting, confusion, to visual symptoms such as the case reported. Ophthalmological complaints can be secondary manifestations of systemic diseases and the correct investigation, often multidisciplinary, is crucial for the diagnosis and management of the patient.

Palavras Chave

papilledema, intracranial lesion, disc swelling

Area

CLINICAL RETINA