|Year : 1965 | Volume
| Issue : 1 | Page : 39-40
KS Mehra, KC Mukerjee, KN Gour
College of Medical Sciences, Varanasi, India
|Date of Web Publication||21-Feb-2008|
K S Mehra
College of Medical Sciences, Varanasi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mehra K S, Mukerjee K C, Gour K N. Foster-Kennedy Syndrome. Indian J Ophthalmol 1965;13:39-40
The typical syndrome described by Foster-Kennedy, namely, optic atrophy on the side of the lesion and papilloedema on the opposite side is rarely come across. Incomplete and atypical forms have been recorded and in some cases a reverse syndrome is reported where the lesion is on the side opposite to the optic atrophy. (Frezzoti-1955).
It has localizing value for it indicates a space occupying lesion over the intracranial part of one of the optic nerves just in front of the chiasma. The pressure on the optic nerve of one side by the tumour causes pressure atrophy of that nerve, at the same time it secludes the vaginal space around that nerve from the cerebral subarachnoidal space and that round the other optic nerve in which the CSF is at a higher pressure than normal and which becomes responsible for papilloedema on the opposite side.
Such tumours are mostly gliomas and meningiomas in connection with the frontal lobe, the olfactory groove, the chiasma, and the sphenoidal wing. Not all the tumours in these situations will give rise to the Foster-Kennedy Syndrome. As a matter of fact, even in these classical situations, the incidence is very rare.
This syndrome can also result from vascular lesions as reported by Martelli (1955), Alema (1959) and Hugonnier (1960). It has also been recorded in tuberculous meningitis by Silamos (1960). Various authors have reported on its incidence. Sifting the various reports on its incidence one feels that it may not be found in more than 2% of all cerebral tumours.
Sphenoid wing meningioma is the most common cause to give rise to this syndrome. In a series of 1400 patients of Bynke (1958) only 17 had the Foster-Kennedy Syndrome, out of these in 11 patients it was due to sphenoid wing meningioma, while out of 180 patients of frontal lobe tumours only one had a positive Foster Kennedy Syndrome. Huber had further confirmed that meningiomas are the common cause in this syndrome, because in his series (1961) two patients out of 25 of meningiomas of sphenoid wing and 3 out of 16 cases of meningiomas of olfactory groove showed presence of the Foster Kennedy Syndrome.
A typical case of the Foster Kennedy Syndrome seen by us is reported.
| Case Report|| |
A young man aged 20 years attended the out-patients department of the Hospital, with the complaints of constant headache, giddiness, vomiting after meals and inability to walk easily. The duration of these complaints was of three months. History of past-illnesses and the family history were non-contributory.
Physical Examination. Patient looked ill, anaemic, B.P. 126/80, pulse, temperature, respiration were normal. Cardio-vascular system, respiratory system, gastro intestinal system, were all normal.
Nervous System. His behaviour was dull, apathetic, and lacking in initiative. Complete anosmia was present on both sides.
Ocular Findings. The anterior segments of the eyes the tension and ocular movements were normal. Pupils were sluggish in reaction to light, more so on the left side.
Vision. Unaided vision of the right eye was 6/12, that of the left eye 6/60. Refraction under a mydriatic was emmetropic. Because of his mental condition it was not possible to take his fields.
Fundus. Right eye:--The optic disc was hyperemic and oedematous by about 4-5 D, veins were engorged and tortuous, exudates and hemorrhages were present all over the fundus.
Left eye:-The disc was pale, more marked on the temporal side, margins were well defined except on the nasal side. Blood vessels were normal.
Blood cytology, blood chemistry, examination of the C.S. fluid and other laboratory investigations were non-contributory.
Ordinary X-Ray of skull did not reveal any abnormality. Angiography was done and it revealed that the first part of the left anterior cerebral artery was displaced upwards and backwards in the lateral view and across the mid line in A.P. view, suggesting a space occupying lesion in the inferomedial part of the left frontal lobe.
A frontoparietal craniotomy was done. A tumor 2.5 cms. was found at inferomedial portion of the left frontal lobe, which was enucleated by fingers easily as it seemed to be encapsulated and not much vascular. The report of the pathologist was that it was an Ependymoma.
After removal of the growth the patient was well for about a week but then gradually he became apathetic and was lying quietly all the time on his bed. Gradually he passed into a stage of unconsciousness. A gradual proptosis of he right eye took place and a mass could be felt in the upper and inner angle of the orbit. The growth was cystic but irreducible. Further he developed chemosis of the bulbar conjunctiva. He was put on achromycin capsules but it was to no avail and finally he died.
On autopsy a huge tumour about the size of a grape fruit situated below the frontal lobe was seen. This tumour had compressed and displaced the frontal lobe. The tumour was within the dura but had eroded the roof of the orbit and nose on the left side from which it could be taken out.
| Summary|| |
A typical case of Foster-Kennedy Syndrome is being presented. The cause for it was an ependymoma in connection with the frontal lobe, which is quite rare.
| References|| |
Alema Gaud Vanii D'Orio. R. (1959) 34: 570.
Bynke (1958) A.M.A. Arch. of Ophth. 36: 129.
Frezzoti J. (1955) Boll. ocul. 34: 498.
Huber (1961) P. 200-220, Eye Symptoms and brain tumour. C. V. Mosby and Co, St. Louis.
Hogonnier, Ravaolt (1960) Bull. Soc; Ophthal. 430.
Martelli A. (1955) Riv. oto. neuro. et. psychiat. belg. (1955).
Silanos G. Berger G. P. (1960) Riv. oto. neuro. oftal 35: 513.