title: Bilateral optic disc edema as a presentation of an obstructing spinal plasmacytoma.
abstract: OBJECTIVE
  To report a rare case of bilateral optic disc edema as presentation of an obstructing spinal plasmacytoma.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  A 41-year-old healthy man presented with distortion of his peripheral vision for 9 months. He denied headaches or neurologic symptoms. Examination showed bilateral optic disc swelling, radial disc hemorrhages, and absent spontaneous venous pulsations. Brain magnetic resonance imaging (MRI) and magnetic resonance venography were unrevealing. Lumbar puncture showed a normal opening pressure of 19 cm cerebrospinal fluid (CSF). CSF protein was significantly elevated at 3.22 g/L (0.10-0.45 g/L). Spinal MRI with contrast revealed a tumor in the T9 vertebral body extending through the disc spaces into T8 and T10, compressing the spinal cord. Computed tomography-guided biopsy confirmed a spinal plasmacytoma. He received radiotherapy to the spine T7-T11 to reduce spinal cord compression followed by a 6-month course of chemotherapy with dexamethasone, cyclophosphamide, and thalidomide. Disc swelling improved on starting radiotherapy with complete resolution 8 months posttreatment. MRI spine showed reduction of tumor.
  
  
  CONCLUSIONS
  This case highlights the importance of spinal imaging in patients with normal cranial scans and raised CSF protein levels who lack the typical idiopathic intracranial hypertension phenotype.
authors.affiliation: Department of Ophthalmology, Aintree University Hospitals NHS Foundation Trust, Liverpool - UK.
authors.forename: Andre
authors.initials: A
authors.lastname: Grixti
authors.affiliation: Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool - UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Bonello
authors.affiliation: Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool - UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Silver
authors.affiliation: Department of Ophthalmology, Aintree University Hospitals NHS Foundation Trust, Liverpool - UK.
authors.forename: Carmel
authors.initials: C
authors.lastname: Noonan
authors.affiliation: Department of Ophthalmology, Aintree University Hospitals NHS Foundation Trust, Liverpool - UK.
authors.forename: Kimia
authors.initials: K
authors.lastname: Ziahosseini
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism; D002555:Cerebrospinal Fluid; D002556:Cerebrospinal Fluid Proteins / Q000378:metabolism; D003131:Combined Modality Therapy; D006801:Humans; D007427:Intracranial Pressure; D008279:Magnetic Resonance Imaging; D008297:Male; D010211:Papilledema / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D010954:Plasmacytoma / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D011559:Pseudotumor Cerebri / Q000175:diagnosis* / Q000628:therapy; D018714:Radiotherapy, Adjuvant; D013117:Spinal Cord Compression / Q000175:diagnosis* / Q000628:therapy; D013125:Spinal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D013904:Thoracic Vertebrae; D041623:Tomography, Optical Coherence; D014057:Tomography, X-Ray Computed
chemical_list: D002556:Cerebrospinal Fluid Proteins; D002097:C-Reactive Protein