Radiation Optic Neuropathy

A patient with a history of skull base meningioma status-post gamma knife radiation presented with three weeks of decreased vision in both eyes. She had no light perception in the right eye and a visual acuity of 20/50 in the left. Magnetic resonance imaging of the brain and orbit demonstrated a large tuberculum sellae meningioma with compression of the right optic nerve. The patient underwent R frontotemporal craniotomy, intradural resection of meningioma, and right optic nerve sacrifice with neurosurgery and had no objective change in her vision. Fifteen months later, she presented again with worsening of vision and had no light perception in either eye. MRI demonstrate no recurrence of the meningioma, and the patient was treated with intravenous steroids for presumed radiation optic neuritis. Short-interval follow up showed minimal improvement of the patient’s vision in the left eye, and onset of visual hallucinations consistent with Charles Bonnet Syndrome. The patient returned to her assisted living facility and was subsequently lost to follow-up.

Presentation Date: 03/17/2022

Issue Date: 03/25/2022