title: Partial visual recovery from radiation-induced optic neuropathy after hyperbaric oxygen therapy in a patient with Cushing disease.
abstract: Here we describe the case of a 41-year-old woman with a history of Cushing disease who had previously undergone unsuccessful neurosurgery, followed by stereotactic radiosurgery. More than 4 years after this treatment, she presented severe visual impairment, which started in the left eye and was documented by neuro-ophthalmic evaluation. Radiological assessment by contrast-enhanced magnetic resonance (MR) imaging initially suggested the diagnosis of glioma of the optic nerve and the patient started corticosteroid treatment (first with prednisone, 80 mg/day, followed by dexamethasone, 8 mg/day). Despite the therapy, vision in the left eye rapidly worsened until light was no longer perceptible; similar symptoms and signs also developed in the right eye, evolving to complete temporal hemianopsia. The clinical evidence was confirmed by the rapid progression of the MR picture, which showed homogeneous enhancement of the chiasm and optic nerves. On the basis of these findings, the original diagnosis of glioma was excluded, and radiation-induced optic neuropathy was diagnosed. As corticosteroids had proved inefficacious, hyperbaric oxygen (HBO) therapy was promptly instituted and vision steadily started to improve. This improvement was documented and confirmed by the progressive recovery of the visual field in the right eye and the changes in the sequential follow-up MR scanning. Optic neuropathy is an infrequent but dramatic complication of radiation therapy. Symptoms develop, on average, 12 months after treatment, and the onset may be acute and characterized by the progressive loss of vision in one or both eyes. HBO has already been used to treat this complication, but its efficacy is still controversial. Here, in addition to describing this particular case, which presented a significantly delayed radiation injury of the optic pathways, we provide a brief literature review and discuss some important points.
authors.affiliation: Department of Endocrinological and Metabolic Sciences and Center of Excellence for Biomedical Research, University of Genoa ans San Martino Hospital, Italy.
authors.forename: Mara
authors.initials: M
authors.lastname: Boschetti
authors.forename: Massimo
authors.initials: M
authors.lastname: De Lucchi
authors.forename: Massimo
authors.initials: M
authors.lastname: Giusti
authors.forename: Claudio
authors.initials: C
authors.lastname: Spena
authors.forename: Guido
authors.initials: G
authors.lastname: Corallo
authors.forename: Umberto
authors.initials: U
authors.lastname: Goglia
authors.forename: Enrica
authors.initials: E
authors.lastname: Ceresola
authors.forename: Eugenia
authors.initials: E
authors.lastname: Resmini
authors.forename: Lara
authors.initials: L
authors.lastname: Vera
authors.forename: Francesco
authors.initials: F
authors.lastname: Minuto
authors.forename: Diego
authors.initials: D
authors.lastname: Ferone
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation; D009901:Optic Nerve Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D047748:Pituitary ACTH Hypersecretion / Q000150:complications / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000209:etiology / Q000628:therapy*