A CASE REPORT: BILATERAL PERIPAPILLARY HEMORRHAGE WITH SEVERE VISUAL LOSS DUE TO INTRACRANIAL MULTIFOCAL ANAPLASTIC ASTROCYTOMA WITH CHIASMATIC INVOLVEMENT

個案報告：因顱內多發性未分化性星狀細胞瘤進犯視交叉導致之雙側視神經盤出血及嚴重視力損傷

徐浩恩(Hao-En Hsu) ； 周介仁(Jie-Ren Jou) ； 魏銘政(Ming-Cheng Wei) ； 黃家俊(Gu-Jun Huang) ； 葉坤土(Kun-Tu Ye) ； 薛俊仁(Jun-Ren Xue)

《中華民國眼科醫學會雜誌》 55卷 (2016/12) Pp. 61-66

https://doi.org/10.30048/ACTASOS.201612_55.0010

摘要

Purpose: To present a case of bilateral peripapillary hemorrhage with severe visual loss due to intracranial multifocal anaplastic astrocytoma with chiasmatic involvement. Method: Case report. Result: We present a 58 year-old male patient who suffered with bilateral rapidly visual loss within 1 week. Fundoscope revealed severe bilateral peripapillary hemorrhage and disseminated blot retinal hemorrhage at posterior pole. Brain MRI showed a huge intracranial tumor over bilateral frontoparietal and right temporal lobes, which crossed midline through the corpus callosum. In addition, invasion of optic chiasm and bilateral optic nerve was noted. Brain biopsy by neurosurgeon was performed and anaplastic astrocytoma was proved by histopathology. The patient received a complete course of radiation therapy, which was divided into 32 fractions with total cumulative dose of 6120 centigray. However, he expired 2 months after radiation therapy due to deterioration of general condition. Bilateral peripapillary hemorrhage with severe visual loss secondary to brain anaplastic astrocytoma is an ominous sign with poor clinical outcome, even with aggressive intervention by radiotherapy. Conclusion: In this case report, we show an uncommon case of chiasmatic anaplastic astrocytoma with specific ocular findings as above.

關鍵字

Bilateral peripapillary hemorrhage ； anaplastic astrocytoma ； visual loss ； chiasmatic involvement

並列摘要

目的：報告一名因顱內多發性未分化性星狀細胞瘤進犯視交叉導致之雙側視神經盤出血及嚴重視力損傷之個案。方法：病例報告。結果：患者是58歲男性，因一週內雙眼視力模糊求診。眼底鏡檢發現雙側嚴重視乳突出血併後極部視網膜瀰漫性點狀出血。腦部核磁共振掃描發現雙側大腦前葉、頂葉、胼胝體及右側顳葉有腫瘤進犯。另視交叉及雙側視神經亦發現腫瘤進犯。腦組織穿刺取樣之病理組織為未分化性星狀細胞瘤(Anaplastic astrocytoma)。患者接受顱部放射治療，共32次，累積劑量6120厘葛雷(Centigray)。然放射治療後病情仍持續惡化，最後於治療後兩個月死亡。結論：因顱內多發性未分化性星狀細胞瘤進犯視交叉，導致之雙側視神經盤出血及嚴重視力損傷之個案較為少見。顱內未分化性星狀細胞瘤所致雙側視乳突出血合併視力迅速惡化，為疾病之惡性表徵，儘管 接受放射治療預後仍不甚理想。