Malignant optic glioma presenting as an acute anterior optic neuropathy.
OBJECTIVE
To describe an uncommon case of malignant optic glioma and the challenges in its diagnosis.


METHODS
Case report with funduscopic, magnetic resonance imaging (MRI), and automated field test correlations.


METHODS
A 60-year-old man presented with a 1-week history of left optic disk swelling and optic neuropathy that was initially diagnosed as nonarteritic anterior ischemic optic neuropathy (NA-AION).


RESULTS
His clinical course deteriorated with progressive vision loss, acute orbital inflammation, and central retinal vein and artery occlusion, despite an improvement with a short course of steroids. MRI revealed enhancement of the left optic nerve, chiasm, and left optic tract. Initial optic nerve biopsy was negative and biopsy of optic tract confirmed a diagnosis of glioblastoma multiforme grade 4. The patient died 4 months after biopsy despite chemotherapy and radiotherapy.


CONCLUSIONS
The diagnoses of malignant optic glioma, anterior ischemic optic neuropathy, and optic neuritis have significant overlap of signs and symptoms. The authors report a case that demonstrates the difficulties in diagnosis, and propose additional presenting features of malignant optic glioma.
From the *Department of Ophthalmology and †Department of Anatomical Pathology, ICPMR, Westmead Hospital; and ‡Department of Anatomical Pathology, Royal Prince Alfred Hospital, NSW, Australia.
Chandra
C
Balachandran
Michael James
MJ
Millar
Rajmohan
R
Murali
Carl
C
Bulliard
Capon M
CM
Malcolm
Anthony
A
Maloof