title: Papilledema in obstructive hydrocephalus caused by giant cell astrocytoma of tuberous sclerosis.
abstract: A 5-year-old girl with progressive hemiparesis and headache was found by brain imaging to have a large tumor centered at the foramen of Monro, blocking cerebrospinal outflow and producing massive lateral ventriculomegaly. Total excision of the mass led to a pathologic diagnosis of giant cell astrocytoma. Dermatologic abnormalities had been detected shortly after birth but were unexplained. Abdominal imaging disclosed renal cysts, and ophthalmologic examination disclosed papilledema and retinal plaques. On this basis, a diagnosis of tuberous sclerosis (TS) was finally made. Two months after surgery, papilledema had resolved, and visual function appeared to be normal. Although the patient apparently escaped visual loss, other reports affirm that giant cell astrocytoma, a common tumor in TS, may go undetected for long enough to produce irreversible optic neuropathy from chronic papilledema. Because patients with TS may not report visual loss, they should undergo periodic ophthalmologic screening.
authors.affiliation: Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan 48105, USA.
authors.forename: Deborah Y
authors.initials: DY
authors.lastname: Chong
authors.forename: Parima
authors.initials: P
authors.lastname: Hirunwiwatkul
authors.forename: Paul E
authors.initials: PE
authors.lastname: McKeever
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Trobe
mesh_terms: D001254:Astrocytoma / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D002551:Cerebral Ventricle Neoplasms / Q000150:complications* / Q000175:diagnosis; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D008279:Magnetic Resonance Imaging; D019635:Neurosurgical Procedures / Q000379:methods; D010211:Papilledema / Q000175:diagnosis / Q000209:etiology*; D014402:Tuberous Sclerosis / Q000150:complications* / Q000175:diagnosis