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First Author: M.Gessa SPAIN
Co Author(s): B. Fernandez-Perez R. Angeles I. Relimpio
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To describe the clinical case of a patient who comes in for rapid onset of bilateral visual loss.
Hospital Universitario Virgen Macarena, Sevilla, Spain. Clinical case with explanatory images of nuclear magnetic resonance (NMR), pathology and surgical biopsy.
Male, 57. Personal history: dyslipidemia. Background Ocular LASIK 10 years ago. Complaint: bilateral vision loss of 10 days" duration. Eye examination: BCVA: 0.1 RE, 0.1 LE. Need to move his head to read the eye chart. BMC: bilateral mydriasis no reactive to light. Rest no findings Normal IOP and fundus. Perimetry: bitemporal heteronymous hemianopsy. Suspected clinical chiasmatic syndrome. Possible etiologies: tumor, vascular, inflammatory or other. Sella MRI with gadolinium enlarged optic chiasm. The output of both the optic nerve and optic tracts sample of very intense contrast uptake. Pituitary unaltered.
Given the high suspicion of tumor in sellar lesion biopsy is decided. Biopsy pilocytic astrocytoma grade I. PAGF + spindle cells with little atypia. Unable to complete tumor resection Treatment plan: fractionated stereotactic radiotherapy. - 27 sessions of 2 Gy - Total radiation dose: 54 Gy - Good response - No acute side effects Visual acuity at 1 month: bilateral amaurosis. Evolution in 5 months the patient: Loss of balance, drowsiness incontinence. NMR: Active hydrocephalus third ventricle and lateral ventricles Action: Set bypass valve type Codman A 3. Post surgery evolution:was decreasing ventricular size Remains admitted for study and treatment of pituitary dysfunction by Internal Medicine: ADH inhaled. Pyelonephritis and ICU admission 2 days to stabilization. Evolution in seven months: Decreased consciousness, disorientation, dysdiadochokinesia CT: ischemic stroke in the Territory of the vertebrobasilar system (third back hemispheres, thalamus, and cerebellum trunk) The patient falls into semicomatose Pharmacological coma is induced Dies of cardiac arrest
The study of the visual field changes must be accompanied by a complete neurological examination low pilocytic astrocytoma grade is a very uncommon tumor in adulthood, more typical of childhood behavior brain tumors, and therefore its forecast, not only is determined by pathology, but for its location and the possibility of a complete resection. This tumor, despite being low grade has caused several nervous system complications in our patient, which have led to his death