|Year : 1984 | Volume
| Issue : 3 | Page : 175-176
Papilloedema caused by spinal tumour in a case of optic nerve glioma-a clinical report
Sanatan Rath, Madhumati Mishra
Department of Neuro-Surgery, S.C.B. Medical College, Cuttack (Orissa), India
Head of the Department, Neuro-Surgery, S.C.B. Medical College Hospital, Cuttack-753 007, Orissa
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Rath S, Mishra M. Papilloedema caused by spinal tumour in a case of optic nerve glioma-a clinical report. Indian J Ophthalmol 1984;32:175-6
Papilloedema associated with spinal tumour is an unusual clinical entity, 47 such cases have been encountered yet. Such patients report to ophthalmologists for headache, papilloedema or failing vision and are usually investigated for intracranial space occupying lesion, the spinal pathology frequently goes undetected because of its rarity.
Recently, we encountered a case of spinal tumour presenting features of Papilloedema. Such is being reported for its rarity, the pathogenesis of the condition has been discussed at length.
| Case report|| |
A 23 year old male RP was admitted with 3 months history of headache, vomiting and visual deficit in right eye. The left eye was enucleated for optic nerve glioma 12 years back. No clinical evidence or orbital or intracranial recurrence was noted. On examination, the right eye had full range of movements, 6/18 vision and papilloedema on funduscopy. There was no neurological deficit. X-ray examination of orbits, optic foramina and left carotid angiography did not demonstrate an intracranial space occupying lesion. Conray ventriculography showed picture of communicating hydrocephalus, hence right ventriculoatrial shunt was given for rapidly failing vision in the right eye. The post operative period was uneventful.
He was readmitted again on after about a year for weakness of legs and acute urinary retention. Examination revealed regressed papilloedema in right eye with 3/60 vision, tenderness over lumbar spine, radicular sensory level, flaccid paraparesis and acute urine retention. Spinal compression at conus was suspected, Cisternal myodil myelography demonstrated an intramedullary tumour at conus with complete block of dye column [Figure - 1]. Also, lumbar puncture at L4-L5 resulted in dry tap indicating obstruction to spinal C.S.F. pathway. Cisternal C.S.F. had protein level of 300 mg % with normal cell count.
On exploration of lumbar spine, an intradural intramedullary tumour, 3 cm X 2cmX2cm was decompressed. Histopathological report was "Grade II Astrocytoma", a course of C.C.N.U. and radiotherapy was given postoperatively. CT scan after spinal decompression demonstrated normalization of ventricular size, the relationship between papilloedema and spinal tumour was thus established.
| Discussion|| |
Papilloedema secondary to spinal tumour is rare and encountered in 0.01 % of cases. The mechanism is ill understood, following theories have been postulated in literature.
1) Spinal tumours inhibit CSF absorption at lumbar cul-de-sac and lead to increased C.S.F. volume.
2) Rise in C.S.F. protein content lead to hyperviscosity and hamper C.S.F. absorption through arachnoid villi.
3) C.S.F. stasis along cranio- spinal axis occur due to hyperviscosity, deposition of colloidal molecules lead to basal adhesions. This explains the progress of optic atrophy in some patients after decompression of the spinal tumour.
4) Tumours like ependymoma secrete fluid and increase in C.S.F. column occur.
5) Deposition of neoplastic cells or products or haemorrhage from the tumour surface over C.S.F. absorbing sites is through off.
Regardless of the mechanism involved, regression of intracranial hypertension after spinal decompression, seen in CT scan, indirectly establish the relationship between papilloedema and spinal tumoral block.
In the present case, finding of papilloedema in right eye suggested an intracranial space occupying lesion and the possibility_ of spinal tumour was not through of initially because of its rarity. Hence, we discuss this case to alert ophthalmologists to the fact that in patients presenting with papilloedema, the presence of a spinal tumour should be excluded before making the diagnosis of "benign intracranial hypertension".
| Summary|| |
A rare case of spinal astrocytoma associated with papilloedema is discussed with review of available literature.
| References|| |
Mehta, D., Krishnan, KR.. Prakash, C., Kak. V.K and Banerjee, A.K., 1981, Neurology India, 30: 195.
Arseni. C and Maretsis, M., 1967. J. Neurosurg, 27: 105.
[Figure - 1]