title: Acute visual loss: just the beginning?
abstract: A 47-year-old man presented with sudden visual loss, optic disk edema, retinal ischemia, and limited upgaze in the left eye. Initial MRI revealed thickened, enhancing left optic nerve. Extensive work-up for an inflammatory and infiltrative etiology was positive only for Borrelia burgdorferi IgM by Western blot. Six weeks later the patient had numbness and weakness on his left side. MRI showed enhancing lesions extending from the left optic nerve to the optic chiasm, along the visual pathways bilaterally, mainly on the right side from optic tract to lateral geniculate body and pulvinar. Stereotactic biopsy of the right pulvinar lesion revealed glioblastoma. The tumor progressed rapidly, and the patient died 11 weeks after the onset of first symptoms.
authors.affiliation: Institute of Neurological Sciences and Department of Neurology, Neuro-ophthalmology Unit, Hacettepe University, Sihhiye, Ankara, Turkey.
authors.forename: Ayse Ilksen
authors.initials: AI
authors.lastname: Colpak
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey.
authors.forename: Ilkay
authors.initials: I
authors.lastname: Isikay
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey.
authors.forename: Melike
authors.initials: M
authors.lastname: Mut
authors.affiliation: Department of Pathology, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey.
authors.forename: Figen
authors.initials: F
authors.lastname: Soylemezoglu
authors.affiliation: Institute of Neurological Sciences and Department of Neurology, Neuro-ophthalmology Unit, Hacettepe University, Sihhiye, Ankara, Turkey. Electronic address: tkansu@hacettepe.edu.tr.
authors.forename: Tulay
authors.initials: T
authors.lastname: Kansu
authors.affiliation: Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Rod
authors.initials: R
authors.lastname: Foroozan
mesh_terms: D000208:Acute Disease; D001932:Brain Neoplasms / Q000175:diagnosis*; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005829:Geniculate Bodies / Q000473:pathology; D005909:Glioblastoma / Q000175:diagnosis*; D006801:Humans; D007511:Ischemia / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010211:Papilledema / Q000175:diagnosis; D020649:Pulvinar / Q000473:pathology; D012171:Retinal Vessels / Q000473:pathology; D014786:Vision Disorders / Q000175:diagnosis*; D014795:Visual Pathways / Q000473:pathology
keywords: acute visual loss; glioblastoma; glioblastoma multiforme; malignant optic glioma of adulthood (MOGA); ophthalmoplegia; optic neuropathy; retinal artery occlusion