Optic Nerve Infiltration in the Setting of a Brain Tumor: A Teenager with a Brain Tumor and Newly Decreased Vision

Abstract

A 14.5-year-old boy presented with poor vision in the right eye. His past medical history was notable for a temporo-occipital primitive neuroectodermal tumor (PNET) with spinal metastases that had been diagnosed 2 years prior. The tumor was treated with surgical resection, chemotherapy, craniospinal irradiation, and autologous bone marrow transplantation. Neuroimaging showed evidence of complete remission. The patient received maintenance therapy with retinoic acid on an experimental protocol following high-dose chemotherapy. One year prior to the current presentation, his visual examination showed visual acuity of 20/30 right eye and 20/20 left eye with evidence of right optic neuropathy on visual field examination. At that time, Humphrey visual field testing showed a nasal step in the left eye and constriction of the visual field in the right eye (Fig. 17.1a, b). This optic neuropathy was interpreted to be secondary to prior optic nerve edema secondary from tumor associated hydrocephalus.