Sudden visual loss later diagnosed as malignant optic glioma of adulthood

This study presents the differential diagnosis of a man who presented with sudden unilateral visual loss and was later diagnosed with malignant optic glioma of adulthood.

The authors report the case of a 47-year-old man with sudden visual loss to no light perception, optic disc edema, retinal ischemia and limited upgaze in the left eye. Cranial MRI revealed a thickened, enhancing left optic nerve.

Extensive work-up for an inflammatory and infiltrative etiology was positive only for Borrelia burgdorferi IgM by Western blot.

Six weeks later the patient had numbness and weakness on his left side. His vision in the right eye soon became affected with worsening MRI necessitating a brain biopsy which revealed glioblastoma. 

The tumor progressed rapidly, and the patient died 11 weeks after the first onset of symptoms.

The authors note that most malignant gliomas of the anterior visual pathway originate from the chiasm or the distal optic nerve; it is unusual to start with acute visual loss and ophthalmoplegia as in the present case. An initial diagnosis of optic neuritis is frequently made, and the true diagnosis can only be made by histopathological examination.

They say it is important to consider malignant optic glioma of adulthood when a patient presents with acute visual loss due to a vascular occlusion and/or anterior optic neuropathy.