Teaching NeuroImage: Glioblastoma Multiforme Presenting as Optic Neuropathy.

Abstract

A 63-year-old man presented with sudden vision loss in the right eye. Funduscopic examination revealed right severe disc edema with peripapillary hemorrhages with no abnormality on the left (Figure 1, A and B). Orbit and brain MRI's showed an extensive enhancing lesion with restricted diffusion involving the right optic nerve (Figure 1, C–F) and FLAIR hyperintense lesions in the right hippocampus (Figure 2A) and parietal lobe (Figure 2, C and D). The patient received oral corticosteroids followed by plasma exchange. Owing to lack of clinical improvement, a new brain MRI was obtained, showing an enlargement of the lesions (Figure 2, E–H). The biopsy of the parietal lesion confirmed the diagnosis of glioblastoma multiforme (GBM). Visual deficit as initial presentation of GBM is rare (13%).1 A neoplastic origin of an optic neuropathy should be considered in enlarged optic nerve with persistent enhancement and marked MRI diffusion restriction.2