[Arachnoid cyst as the differential diagnosis of ischemic optic neuropathy in type-II diabetes].
METHODS
A 71-year-old woman, a diabetic (type IIb) for 27 years, developed bilateral hemianopsia over a period of about 2 years. A few weeks before hospital admission the defect in her visual fields increased more rapidly and double vision occurred intermittently. The hemianopsia was demonstrated by finger perimetry. There was no evidence of heart failure or peripheral vascular disease. Muscle reflexes were normal, but there was a decrease in vibratory sensation in both feet. The cause of the visual disturbance was at first thought to be an ischaemic optic neuropathy.


METHODS
Biochemical tests showed an HbA1 of 12.8%, blood sugar levels were between 230 and 359 mg/dl, and there was increased intravascular platelet activation. Ophthalmological examination confirmed bitemporal hemianopsia and early retinopathy. Magnetic resonance imaging of the skull revealed an intra- and suprasellar cystic space-occupying lesion extending to the right optic chiasma. These findings, taken together, indicated an arachnoidal cyst.


METHODS
After the diabetic metabolic state had been normalized with insulin treatment (average of 30 IU of an intermediary insulin) and dietary measures, the cyst was evacuated stereotactically. The hemianopsia quickly improved markedly and the patient was discharged 4 days after the operation with her vision nearly fully restored.
Rauch
U
U
Arbeitsgruppe Zelluläre Hämostase und Klinische Angiologie, Diabetes-Forschungsinstitut, Universität Düsseldorf.
Tschöpe
D
D
Kahn
T
T
Schwippert
B
B
Ziegler
D
D
Gries
F A
FA
Mödder
U
U
D000368:Aged; D016080:Arachnoid Cysts / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000628:therapy; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D003937:Diagnosis, Differential; D005260:Female; D006423:Hemianopsia / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000628:therapy; D007511:Ischemia / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D009900:Optic Nerve / Q000098:blood supply*; D011677:Punctures; D013238:Stereotaxic Techniques
Arachnoidalzyste als Differentialdiagnose der ischämischen Opticusneuropathie bei Typ-II-Diabetes.