Decreased Vision as Presenting Sign of Progression of Meningioma

Nova Southeastern University, Davie, Florida, USA

Introduction: Brain tumors can present with different symptomatology depending on the location and size of the lesion. Meningiomas account for about 34% of all primary brain tumors, they tend to grow slowly, and may be large in size by the time symptoms present. Symptoms may include headaches, diplopia, visual disturbances, nausea and tinnitus or hearing loss. Case Presentation: A 39 y/o female presented for a contact lens exam with complaints of decreased vision in the left eye for the past 3-6 months. Medical history was significant for a benign cavernous sinus meningioma on the left side diagnosed 3 years prior. No defect was noted on ocular motility or confrontation fields. However, a left afferent pupillary defect was noted and she was unable to appreciate the HRR color plates in the left eye. Best corrected DVA was 20/20 right eye, 20/25 left eye. Pallor of the optic nerve neuro-retinal rim was noted in the left eye only. Humphrey visual field testing revealed an incomplete left hemianopsia. Deviation from the expected: A mild visual complaint in a patient with a known meningioma prompted the patient to present for an eye examination prior to neurological consult. Discussion: Patients with meningiomas require routine ophthalmological and neurological evaluation including imaging studies. The patient was referred to her neurosurgeon and a neuro-ophthalmologist. MRI testing confirmed that the tumor increased in size and affected the prequiasmatic, intracanalicular, and distal intraorbital segment of the left optic nerve. Conclusion: An interdisciplinary approach is recommended for all patients with brain tumors and especially with meningiomas due to the likely presentation of ocular symptoms. Recommendations for ophthalmological baseline and follow up testing will be discussed. Grants: N/A