Abstract
The parents of a 17-month-old girl reported that their daughter had developed shimmering horizontal movements of the left eye at about 9 months of age. Emergency pediatric evaluation suggested possible spasmus nutans. A head tilt developed one month later at 10 months of age. There was no head nodding. An ophthalmologic examination was requested. A neuro-ophthalmologic evaluation at 17 months of age showed a normal qualitative vision assessment in each eye with normal versions and no strabismus. She had periodic random appearing shimmering movements of the left eye. The pupils were equal, reactive, with no relative afferent pupillary defect. Visual fields were grossly full to toy movement. Moderate bilateral disc pallor was evident with direct ophthalmoscopy. Magnetic resonance imaging (MRI) of the brain demonstrated a chiasmal region solid mass (Fig. 15.1). There were no stigmata of neurofibromatosis type 1 (NF-1). Genetic testing revealed no mutations associated with NF-1. Three-month follow-up MRI and ophthalmologic examinations were scheduled. After 3 months, there was increased size of the mass on MRI with no change in qualitative visual acuity. A biopsy was performed that confirmed the diagnosis of a pilocytic astrocytoma, WHO grade I. A 15-month course of carboplatin with vincristine was initiated and completed.
Original language | English (US) |
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Title of host publication | Fundamentals of Pediatric Neuro-Ophthalmology |
Subtitle of host publication | a Practical, Case-Based Approach to Diagnosis and Management |
Publisher | Springer International Publishing |
Pages | 83-85 |
Number of pages | 3 |
ISBN (Electronic) | 9783031161476 |
ISBN (Print) | 9783031161469 |
DOIs | |
State | Published - Jan 1 2023 |
Keywords
- Carboplatin
- Neurofibromatosis
- Optic nerve glioma
- Pilocytic astrocytoma
- Retinal nerve fiber layer
- Selumetinib
- Vincristine
- Vision loss
ASJC Scopus subject areas
- General Medicine