A 60-years-old female patient, first presented in 2008 with a transient visual impairment of the left eye and pathological visually evoked potentials. Magnetic resonance imaging (MRI) revealed a unilateral, concentric, enhancing lesion encasing the non-enhancing left optic nerve sheath (Fig. 1). Cerebrospinal fluid showed a mild pleocytosis with negative oligoclonal bands and no intrathecal immunoglobulin synthesis. In 2011, a second episode of transient visual impairment of the left eye occured, which spontaneously regressed. CSF diagnostics again showed pleocytosis with evidence of oligoclonal bands in the CSF, whereupon immunosuppressive therapy was initiated under the suspected diagnosis of an inflammatory CNS disease. In 2018, the patient presented with an external oculomotor nerve palsy. Imaging revealed a thickened optic nerve sheath and a progressive congestion of the optic nerve sheath over the course of 10 years (not shown). CSF showed persistent pleocytosis. After discussion in the interdisciplinary brain tumour board a local radiotherapy was performed under the suspected diagnosis of an optic nerve sheath meningioma.
Fig. 1
Axial T2-weighted MRI from March 2008 (a) revealed a dilatation of the dural space along optic nerve (ON) sheath (arrowhead). Axial (b) and coronal (c) T1-weighted contrast-enhanced fat-suppressed (T1 C+ FS) images demonstrated a concentric, enhancing lesion encasing the compressed, non-enhancing ON, producing the characteristic “tram-track” and “doughnut” appearances (arrows)
Menopause can have a significant impact on the body, with effects ranging beyond the endocrine and reproductive systems. Learn about the systemic effects of menopause, so you can help patients in your clinics through the transition.
Alzheimer's research and care is changing rapidly. Keep up with the latest developments from key international conferences, together with expert insights on how to integrate these advances into practice.
This content is intended for healthcare professionals outside of the UK.
