Bilateral Blindness as an Initial Finding of Occipital Lobes Meningioma Metastated from Lung Cancer

Abstract

Introduction: Meningioma may increase intracranial pressure (ICP) and cause papilledema, which results bilateral blindness. Since elevated ICP is thought to be caused by an underlying condition, immediate neuroimaging is required to look into the possibility of papilledema. Patients with intracranial tumour sometimes being consulted to ophthalmologist with ocular problems as their complaint. The purpose of this report is to describe a case of papilledema as an initial finding of occipital lobes intracranial tumor metastated from lung cancer. Case presentation: A female, 50-year-old patient being consulted from the ward with chief complaint bilateral visual loss gradually worsening in the last three months. Further history taking revealed other symptoms including relapsing headache since a year ago. Patient also came to the ophthalmologist a year ago and get examinated because of the headache and the examination result is only refraction disorder. Patient had decrease of consciousness and started coughing with massive sputum production since a week ago before she is admitted to the hospital. Patient was undergone Lung CT scan, a large mass was found in left lung, then she is diagnosed with lung cancer. Before that she never have any complaints about shortness of breath and chronic cough. The visual acuity on both eyes were already no light perception at the initial visit. Anterior segment was calm but the pupil was mid dilatation with no light reflexes. Fundus examination revealed papilledema, the optic nerve heads edges was blurred. Intraocular pressures were 12 mmHg. A MRI was performed 3 months before the patient got admitted to the hospital and revealed a massive solid mass in the left occipital lobe (approx AP 4 x LL 5 x CC 5.5 cm). Radiological reading suggested a meningioma. The patient was immediately referred to pulmonologist, neurologist, together with surgical neurology unit. Conclusion: A patient with slow growing intracranial tumour may come quite late to seek medical attention since the symptoms are very mild and bearable. When being consulted, the visual acuity is already no light perception. Ophthalmologist must be aware and consider the metastases of lung cancer into intracranial tumour as a cause of visual loss and therefore not to delay its management.