Sudden bilateral vision loss due to third ventricular cavernous angioma with intratumoral hemorrhage - case report

• Published in: BMC ophthalmology 2019-12, Vol.19 (1), p.259-259, Article 259
• Main Authors: Ishijima, Kan, Shinmei, Yasuhiro, Nozaki, Mayo, Yamaguchi, Shigeru, Chin, Shinki, Ishida, Susumu
• Format: Article
• Language: English
• Subjects: Acuity; Blindness - diagnostic imaging; Blindness - etiology; Blindness - physiopathology; Blindness - surgery; Brain cancer; Brain Neoplasms - complications; Brain Neoplasms - diagnostic imaging; Brain Neoplasms - physiopathology; Brain Neoplasms - surgery; Case Report; Case reports; Cerebral hemispheres; Chiasmal syndrome; Contrast-enhanced MRI; Craniotomy; Defects; Diagnostic imaging; Differential diagnosis; Eye; Eye surgery; Female; Fluorodeoxyglucose F18 - administration & dosage; Functional Laterality; Glioblastoma; Glioblastomas; Gliomas; Headaches; Hemangioma, Cavernous - complications; Hemangioma, Cavernous - diagnostic imaging; Hemangioma, Cavernous - physiopathology; Hemangioma, Cavernous - surgery; Hemorrhage; Humans; Intracranial Hemorrhages - complications; Intracranial Hemorrhages - diagnostic imaging; Intracranial Hemorrhages - physiopathology; Intracranial Hemorrhages - surgery; Intratumoral hemorrhage; Magnetic Resonance Imaging; Middle Aged; NMR; Nuclear magnetic resonance; Ophthalmology; Optic chiasm; Patients; Positron emission tomography; Radiopharmaceuticals - administration & dosage; Sudden bilateral vision loss; Surgery; Third Ventricle - pathology; Third ventricular cavernous angioma; Tumors; Ventricle; Vision; Visual Acuity - physiology; Visual field; Visual Field Tests; Visual Fields - physiology
• ISSN: 1471-2415; 1471-2415
• DOI: 10.1186/s12886-019-1252-5

We report a rare case of sudden bilateral vision loss due to third ventricular cavernous angioma with intratumoral hemorrhage. A 45-year-old woman presented decreased visual acuity in both eyes. Her best corrected visual acuity was 0.1 in the right eye and 0.15 in the left eye. Goldmann perimetry showed bilateral central scotomas and bitemporal visual field defects. MRI demonstrated a lesion with mixed hypo- and hyperintensity at the optic chiasm, which was thought to be an intratumoral hemorrhage. The patient underwent bifrontal craniotomy. The tumor was exposed via an anterior interhemispheric approach, and histological evaluation of the mass led to a diagnosis of cavernous angioma. Six months after the surgery, her best corrected visual acuity was 0.9 in the right eye and 0.9 in the left, with slight bitemporal visual field defects. Third ventricular cavernous angioma is considered in the differential diagnosis of chiasmal syndrome. Contrast-enhanced MRI and FDG-PET might be useful for differential diagnosis of cavernous angioma from other chiasmal tumors including glioblastoma.