Atlas of Ophthalmology

Bitemporal Optic Nerve Atrophy and Hemianopsia in Suspected Central Neurocytoma (Colour Photography Posterior Pole, SD-OCT, Visual Field, cMRI)

Patient: 13 years of age, male, BCVA 0.4 at OD, 0.9 at OS. General Medical History: new onset, single episode of generalized tonic-clonic seizure , MRI showed unclear cerebral tumor. Ocular Medical History: up to the time of presentation no subjective problems with vision. Purpose: to show bitemporal and diffuse optic nerve atrophy in suspected central neurocytoma after a new onset, single episode of generalized seizure.        Methods: Colour Photography Posterior Pole, SD-OCT, Visual Field, cMRI. Findings: Colour Photography Posterior Pole: regular optic nerve head in OD and OS. SD-OCT: diffuse and temporally decreased retinal nerve fiber thickness in OD>OS Visual Field: hemianopsia at OD, complete visual field defect at OS. Cranial MRI: Coronal T1-weighted and (B) sagittal T2-weighted magnetic resonance images showing  cystic frontobasal and suprasellar lesion with intra- and extraventricular parts with increased T2-signal, no contrast media uptake and no diffusion restriction. Only slight perifocal edema. The maximal extent is 68 x 43 x 58 mm. In summary, this lesion is most likely a central neurocytoma. Discussion: Homonymous hemianopia is usually secondary to stroke, head trauma, and tumors. The characteristics of visual field defects can be helpful in lesion location. Zhang X et al. (1) described the clinical characteristics and clinical-anatomic correlations of homonymous hemianopia. He found that  causes of homonymous hemianopia included stroke (69%), trauma (13%), tumor (11%), brain surgery (2%),  and demyelination (1%). The lesions were most commonly located in the occipital lobes (45%) and the optic radiations (32.2%). Neurocytomas (2, 3) are rare central nervous system tumors in intraventricular sites, in the brain and spinal cord parenchyma. Cerebral neurocytomas are histologically low-grade tumors and radical surgery is curative. Literature: (1) Zhang X, Kedar S, Lynn MJ, Newman NJ, Biousse V. Homonymous hemianopias: clinical-anatomic correlations in 904 cases. Neurology. 2006 Mar 28;66(6):906-10. (2) Peng P, Chen F, Zhou D, Liu H, Li J. Neurocytoma of the pituitary gland: A case report and literature review. Biomed Rep. 2015 May;3(3):301-303. (3) Mpairamidis E, Alexiou GA, Stefanaki K, Sfakianos G, Prodromou N. Extraventricular neurocytoma in a child: case report and review of the literature. J Child Neurol. 2009 Apr;24(4):491-4.

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