Abstract
Introduction: Optic nerve gliomas are rare tumors that are mainly observed in children. Exophthalmos and strabismus are the main signs of the disease. Neuroimaging and in particular magnetic resonance imaging is of great help in the diagnosis and follow-up of these tumors. The therapeutic management of these gliomas involves different means: surgical removal, chemotherapy, radiotherapy or abstention under surveillance. The indications must be discussed on a case-by-case basis. We report in this work a case of optic nerve glioma revealed by a strabismus and a unilateral exophthalmos. Case Report: This is a 3-year-old girl from a non-consanguineous marriage, with no specific pathological ATCD, who presented with divergent strabismus with left exophthalmos evolving for 3 months. The ophthalmologic examination noted a constant wide-angle divergent strabismus on the left eye with moderate exophthalmos on the same side. Corrected visual acuity was reduced to near finger count on the left and 5/10 on the right. Somatic examination found café au lait spots on the back and trunk. Cerebral CT showed a bilateral thickening of the optic nerves, fusiform and regular, more marked on the left, isodense to spontaneous contrast, homogeneously enhancing after injection of PDC. On the left, it is responsible for a downward refoulement of the eyeball with grade 1 exophthalmos. An MRI was ordered revealing a regular well-limited fusiform thickening of the optic nerves in T1 isosignal, intermediate in T2 and FLAIR, in diffusion hypersignal without ADC restriction, intensely and finely heterogeneous enhancing after injection of contrast medium. This thickening is responsible for a grade I left exophthalmos, with widening of the optic canals posteriorly and filling of the intraconical fat evoking a glioma appearance. The child was referred to neurosurgery for management. Conclusion: The diagnosis of optic nerve glioma in children is rare, with atypical presentations both in terms .........
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