Compressive Optic Neuropathy in a Patient with Provisional Diagnosis of Huge Meningioma-A Case Report

巨大腦膜瘤造成之壓迫性視神經病變－個案報告

范乃文(Nai-Wen Fan) ； 王安國(An-Guor Wang) ； 顏美媛(May-Yung Yen)

《中華民國眼科醫學會雜誌》 50卷1期 (2011/04) Pp. 199-204

https://doi.org/10.30048/ACTASOS.201104.0030

摘要

目的：報告一例巨大腦膜瘤造成之壓迫性視神經病變。方法：觀察性病例報告。結果：一位由他院轉診至我們醫院的25歲女性主訴右眼視力模糊及頭痛一個月，過去三個月因無經症接受口服避孕藥治療。其最佳矯正視力右眼零點捌，左眼壹點貳。眼內壓正常。神經學檢查發現右眼有相對性瞳孔傳入障礙。石原假同色測驗板右眼可讀14片，左眼可讀15片。眼底檢查正常。視野檢查顯示右眼視野中央暗點。磁振造影顯示大於10公分之巨大腦膜瘤侵犯雙側額部，上鞍部，阻塞右側上眶裂孔，視神經孔，視神經交叉，包圍右側海棉竇，且嚴重壓迫右側腦幹並向下延伸至頸部脊髓。結論：巨大腦膜瘤壓迫腦幹並向下侵犯頸部脊髓是很罕見之案例。且巨大腦膜瘤只造成壓迫性視神經病變而無其他神經學上之缺失更為鮮少。因此對於如此單純只有壓迫性視神經病變之患者，巨大腦膜瘤之鑑別診斷亦應考量在內。

並列摘要

Purpose: To present an unusual huge meningioma found in a patient with isolated compressive optic neuropathy. Methods: Observational case report Results: A 25-year-old woman, referred to our hospital, had a 1-month history of blurred vision in her right eye and headache over the occipital area. She had received oral contraceptives for three months due to amenorrhea. Her best-corrected visual acuity was 6/7.5 in the right eye and 6/5 in the left. Intraocular pressure was normal. Neurologic examination showed a relative afferent pupillary defect in the right eye. She could identify 14 plates in the right and 15 plates in the left with the Ishihara color test. Fundus examination was normal in both eyes. The visual field disclosed a central scotoma in the right eye. Magnetic resonance imaging revealed a huge mass isotense on T1-weighted and T2-weighted images, which was most likely a meningioma. This tumor was larger than 10 cm in size. It involved bilateral frontal bases, right clivopetrosal region, and suprasellar region, with obliteration of right superior orbital fissure, optic canal, orbital apex, and optic chiasm. It encased the right cavernous sinus with severe compression to the right aspect of the brain stem, extending downward into the level of the C-spine. Conclusions: Huge meningioma with brain stem and C-spine compression is uncommon. It is rare for such a huge meningioma to present as an isolated compressive optic neuropathy without other neurological symptoms. Thus, even in a case with isolated optic neuropathy, huge meningioma should be considered in the differential diagnosis.

並列關鍵字

Compressive optic neuropathy ； huge meningioma