A 79-year-old woman presented to our emergency department with subacute, sequential, severe optic neuropathies and encephalopathy. She had been treated for suspected giant cell arteritis at an outside facility several months earlier (elevated erythrocyte sedimentation rate and minimal left optic nerve enhancement). On our evaluation she had panhypopituitarism and a large, gadolinium-enhancing optic apparatus mass extending through the hypothalamus and into the frontal lobes (figure, A). Biopsy diagnosed grade IV fibrillary astrocytoma (glioblastoma multiforme; figure, B and C). Optic nerve gliomas are typically low-grade and diagnosed in childhood, while rare adult cases are often high-grade glioblastoma as in the present case.1,2
(A) Coronal T1 postgadolinium MRI showing heterogeneously enhancing mass centered within the suprasellar cistern involving the optic apparatus and hypothalamus extending superiorly to involve the inferior frontal lobes. (B, C) Biopsy specimen histologic section shows hypercellular fibrillary malignant neoplasm with moderate cytologic atypia and rare apoptotic bodies (hematoxylin-eosin stain, 400× original magnification).
Footnotes
Disclosure: Dr. Burrus reports no disclosures. Dr. Drake receives research support from the NIH (NCI 2R01 CA 107476-6 [coinvestigator] and NIA P01 AG 004875 [coinvestigator]. Dr. Sanderson reports no disclosures. Dr. Keegan serves as a Section Editor for Neurology® and as Chief Editor of eMedicine and has served as a consultant for Novartis.
- Received February 11, 2010.
- Accepted September 1, 2010.
- Copyright © 2010 by AAN Enterprises, Inc.
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