Diagnosis
Glioblastoma multiforme (GBM) with infiltration along the optic
tract. Radiographic features included an inhomogeneous mass with
nodular, peripheral enhancement, and an infiltrative pattern of
growth. Lesions which could potentially be included in the
differential diagnosis are primary optic chiasmal glioma,
meningioma, abscess, and metastases.
Findings
Postoperatively, an incomplete left homonymous hemianopsia was
evident. During radiotherapy, the patient developed new onset
left-sided weakness. MR imaging demonstrated progressive disease,
and she underwent a second debulking procedure. Radiotherapy was
completed; however, following two cycles of BCNU, the patient
developed worsening left-sided paresis and a central cranial nerve
VII palsy. The ophthalmologic examination revealed a dense left
homonymous hemianopsia, a new relative left afferent pupillary
defect, and normal visual acuity but no evidence of band atrophy OS
(figure 1). MR imaging confirmed worsening disease with involvement
of the right optic tract and chiasm by tumor (figures 2,3).
Procarbazine was offered for salvage chemotherapy but the patient
continued to decline neurologically, expiring eight months from the
time of her diagnosis.
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