title: [Optic neuropathy and meningioma: a diagnostic trap].
abstract: BACKGROUND
  Meningiomas are benign primary meningeal tumors. Their diagnosis may be incidental or in response to a work-up for neurological or ophthalmological symptoms.
  
  
  METHODS
  The clinical course of five patients with ophthalmological symptoms leading to the diagnosis of meningioma is described.
  
  
  RESULTS
  The case reports consist of five women (48 to 54 years old - mean 52 years at the onset of symptoms), all suffering from a progressive unilateral decrease in visual acuity with a normal initial fundus examination and ipsilateral visual field changes. Ancillary testing, in particular MRI and CT-scans, had to be repeated to make the diagnosis of meningioma, which was delayed from 18 months to 4 years.
  
  
  CONCLUSIONS
  The clinical presentation of these five cases was that of a retrobulbar optic neuropathy, which biased the work-up towards an inflammatory disease of the central nervous system such as multiple sclerosis. However, the atypical character of the neuropathy, which did not respond to intravenous steroids, caused the diagnosis to be questioned and radiological examinations repeated. The iso-intense appearance of meningiomas on T1 MR imaging and only slightly hyperintense appearance on T2 may result in a diagnostic delay if the exam is not performed and interpreted by an experienced professional. Gadolinium contrast, fat suppression and centration on the anterior visual pathways are essential to a proper MRI examination.
  
  
  CONCLUSIONS
  When confronted with a progressive, painless optic neuropathy unresponsive to steroid treatment, the diagnosis of meningioma of the anterior visual pathways must be considered. This diagnosis is enabled by a targeted MRI of the anterior visual pathways.
authors.affiliation: Département d'ophtalmologie, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France. marie.bouyon@orange.fr
authors.forename: M
authors.initials: M
authors.lastname: Bouyon
authors.forename: F
authors.initials: F
authors.lastname: Blanc
authors.forename: L
authors.initials: L
authors.lastname: Ballonzoli
authors.forename: M
authors.initials: M
authors.lastname: Fleury
authors.forename: C
authors.initials: C
authors.lastname: Zaenker
authors.forename: C
authors.initials: C
authors.lastname: Speeg-Schatz
authors.forename: J
authors.initials: J
authors.lastname: de Seze
mesh_terms: D003287:Contrast Media; D003951:Diagnostic Errors; D004172:Diplopia / Q000209:etiology; D005260:Female; D005682:Gadolinium; D013700:Giant Cell Arteritis / Q000175:diagnosis; D006801:Humans; D008279:Magnetic Resonance Imaging; D008577:Meningeal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D008579:Meningioma / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D009901:Optic Nerve Diseases / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D009902:Optic Neuritis / Q000175:diagnosis*; D016634:Radiosurgery
chemical_list: D003287:Contrast Media; D005682:Gadolinium