Optic Nerve Sheath Meningioma Masquerading as Optic Neuritis

Indian Journal of Ophthalmology, 2014

A 60-year-old female presented with gradual, painless, progressive diminution of vision, and progressive proptosis of left eye since 7 years. Ophthalmological examination revealed mild proptosis and total optic atrophy in the left eye. Magnetic resonance imaging (MRI) and computed tomography (CT) brain with orbit showed bilateral optic nerve sheath meningioma (ONSM) involving the intracranial, intracanalicular, intraorbital part of the optic nerve extending up to optic chiasma and left cavernous sinus.

Journal of Neuro-ophthalmology, 2023

Objective: To describe clinical and radiological characteristics of seropositive neuromyelitis optica (NMO) in Emirati patients. While epidemiology of seropositive NMO in Abu Dhabi has been reported in a previous paper, its clinical and MRI profiles among Emirati patients have not been previously fully investigated. Methods: In our case series, we describe clinical and MRI characteristics of 5 Emirati patients with NMO, consecutively admitted at Cleveland Clinic Abu Dhabi, a major tertiary hospital in Abu Dhabi, United Arab Emirates. Results: Patients were all females, mean age of onset (SD) was 41 (11) years, and 67% had autoimmune comorbidities. Most patients initially presented with acute myelitis (80%) while 20% got optic neuritis. Mean (SD) number of further relapses after onset was 3 (1) and mean (SD) disease duration was 12 (11) years. At MRI, apparent longitudinal extensive transverse myelitis was present in all patients affecting mostly the central gray matter of the cervical cord but extending as well to the thoracic portion. Furthermore, seropositive NMO related brain lesions were also observed. Conclusions: Our work provides valuable information regarding seropositive NMO with the potential to increase recognition of this disorder in Abu Dhabi and confirms NMO findings described in the other populations with this disorder. Further research is needed to advance clinical and MRI characterization of seronegative NMO in the region.

Seminars in Ophthalmology, 2013

Meningiomas are benign neoplastic lesions of arachnoidal cells of the meninges. These tumors may arise wherever meninges exists, such as in the nasal cavity, paranasal sinuses, middle ear, and mediastinum. Optic nerve sheath meningiomas (ONSMs) are usually unilateral and occur predominantly in middle-aged females, although they may be present at any age. We present a case of a 55-year-old female with ONSM diagnosed when she was 40 years old. Diagnosis and follow-up was based on the clinical picture, CT orbit scan, and magnetic resonance imaging.

American Journal of Neuroradiology

We describe six cases of cannalicular optic nerve meningioma in which the diagnosis was missed for more than 1 year after the onset of symptoms. Clinical features led to a misdiagnosis of optic neuritis in all cases. Although atypical clinical progression led to further imaging studies, they did not provide the diagnosis because of inappropriate imaging protocols. Diagnosis was eventually made on the basis of high-spatial-resolution contrast-enhanced MR findings. Radiologists should have a high suspicion for the diagnosis of optic canal meningioma in patients with unexplained visual loss, particularly when visual loss is progressive. Investigation in these cases should include high-spatial-resolution MR imaging of the orbit before and after contrast medium administration, and fat suppression should be used in combination with contrast enhancement whenever possible.

AJNR. American journal of neuroradiology, 1996

Journal of Neuro-Ophthalmology, 2007

Romanian Journal of Neurology, 2019

Optic nerve sheath meningiomas (ONSM) are rare, frequently unilateral, benign, slowly growing tumors, arising from the meningo-epithelial cells surrounding the optic nerve intraorbital or intercanalicular. Their localization directly impair vision and indirectly impair aesthetics, making a safe classical surgical intervention very difficult and recommending stereotactic fractionated radiotherapy. Women are more affected, the survival rate is good and imaging can sustain differential diagnosis with optic neuroglioma or orbital schwannoma, lymphoma or pseudo tumor.

AJNR. American journal of neuroradiology

We describe six cases of cannalicular optic nerve meningioma in which the diagnosis was missed for more than 1 year after the onset of symptoms. Clinical features led to a misdiagnosis of optic neuritis in all cases. Although atypical clinical progression led to further imaging studies, they did not provide the diagnosis because of inappropriate imaging protocols. Diagnosis was eventually made on the basis of high-spatial-resolution contrast-enhanced MR findings. Radiologists should have a high suspicion for the diagnosis of optic canal meningioma in patients with unexplained visual loss, particularly when visual loss is progressive. Investigation in these cases should include high-spatial-resolution MR imaging of the orbit before and after contrast medium administration, and fat suppression should be used in combination with contrast enhancement whenever possible.

Cases Journal, 2008

A case of a 75-year old male with right-sided exopthalmos is presented. Outside proptosis of the right eye was initially observed 6 years ago. Opthalmological and endocrinological clinical examination as well as laboratory tests revealed no pathology from optic nerve disc, optic bulb and thyroid related hormones. MRI study demonstrated an optic nerve meningioma. The key imaging findings and the differential diagnosis were discussed in this present paper.

Future Neurology

A small percentage of patients with neuromyelitis optica spectrum disorder (NMOSD) may have radiological manifestations that completely mimic MS. Accurate diagnosis in these patients requires paying attention to patients' history and how they respond to treatment. Here, a patient with NMOSD is introduced, in the MRI scan of whom, the diagnostic criteria of Barkhof were outlined; however, since her blurred vision did not respond to treatment with corticosteroids, she was diagnosed with NMOSD.