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   Table of Contents      
CASE REPORT
Year : 1984  |  Volume : 32  |  Issue : 3  |  Page : 175-176

Papilloedema caused by spinal tumour in a case of optic nerve glioma-a clinical report


Department of Neuro-Surgery, S.C.B. Medical College, Cuttack (Orissa), India

Correspondence Address:
Sanatan Rath
Head of the Department, Neuro-Surgery, S.C.B. Medical College Hospital, Cuttack-753 007, Orissa
India
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Source of Support: None, Conflict of Interest: None


PMID: 6519733

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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

How to cite this URL:
Rath S, Mishra M. Papilloedema caused by spinal tumour in a case of optic nerve glioma-a clinical report. Indian J Ophthalmol [serial online] 1984 [cited 2020 Dec 2];32:175-6. Available from: https://www.ijo.in/text.asp?1984/32/3/175/27414

Papilloedema associated with spinal tumour is an unusual clinical entity, 47 such cases have been encountered yet.[1] 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 Top


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 Top


Papilloedema secondary to spinal tumour is rare and encountered in 0.01 % of cases.[2] The mechanism is ill understood, following theories have been postulated in literature.[1]

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.[1]

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 Top


A rare case of spinal astrocytoma asso­ciated with papilloedema is discussed with review of available literature.

 
  References Top

1.
Mehta, D., Krishnan, KR.. Prakash, C., Kak. V.K and Banerjee, A.K., 1981, Neurology India, 30: 195.  Back to cited text no. 1
    
2.
Arseni. C and Maretsis, M., 1967. J. Neurosurg, 27: 105.  Back to cited text no. 2
    


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