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Rapid onset of bilateral visual loss by pilocytic astrocytoma

Poster Details

First Author: M.Gessa SPAIN

Co Author(s):    B. Fernandez-Perez   R. Angeles   I. Relimpio        

Abstract Details



Purpose:

To describe the clinical case of a patient who comes in for rapid onset of bilateral visual loss.

Setting:

Hospital Universitario Virgen Macarena, Sevilla, Spain. Clinical case with explanatory images of nuclear magnetic resonance (NMR), pathology and surgical biopsy.

Methods:

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.

Results:

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

Conclusions:

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

Financial Disclosure:

NONE

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